Case report Extended esophagolaryngeal resection with parathyroid autotransplantation E. Kourias, N. Arkadopoulos, G. Kostopanagiotou, G. Kinoglou, V. Smyrniotis 2nd Department of Surgery, Aretaieion Hospital, University of Athens School of Medicine, 76 Vas. So®as Ave, GR-11528, Athens, Greece SUMMARY. Esopharyngolaryngeal resection for carcinoma of the cervical esophagus must be accompanied by resection of the thyroid gland, parathyroid bodies, and regional lymph nodes. In order to reduce long-term morbidity associated with the procedure, we performed parathyroid autotransplantation in two patients who underwent esophagolaryngeal resections. Grafting of the upper two parathyroid glands into the sternocleidomastoid muscle was carried out successfully in both cases. Graft function was rapidly restored. During the third post- operative week, blood levels of intact parathormone (PTH) reached 20 pg ml ±1 in the ®rst case and 15 pg ml ±1 in the second, and the patients were successfully weaned o calcium and vitamin D supplementation. Parathyroid autotransplantation should be attempted in all cases of esophagolaryngeal resections provided that parathyroid glands are free of malignancy. INTRODUCTION Esophagolaryngeal resection remains the only eec- tive surgical modality for carcinoma of the cervical esophagus. The thyroid gland, parathyroid bodies, and regional lymph nodes must be excised `en bloc' with the primary tumor. 1,2 Airway patency is secured by a permanent tracheostomy and restoration of continuity of the alimentary tract is accomplished by using stomach, large bowel, or jejunal grafts. 3,4 However, ablation of the thyroid and parathyroid glands deprives the patients of thyroxine and parathormone (PTH) and increases the long-term morbidity associated with curative resections. This study presents our experience with parathyroid autotransplantation after extended esophagolaryngeal resections. CASE REPORTS Case 1 A 64-year-old woman was diagnosed as having squamous carcinoma of the cricoid area of the esophagus. The patient was initially treated with radiotherapy without response, followed by surgical treatment. The neck was explored through a hori- zontal incision and esophagolaryngeal resection was judged to be appropriate. The trachea was divided and a permanent tracheostomy was fashioned. The upper parathyroid glands were identi®ed and resect- ed. Division of the pharynx was carried out below the hyoid bone. The abdomen was entered via a middle subxyphoid incision and the stomach was mobilized, taking care not to disrupt the blood supply of the right gastric and gastroepiploic vessels. A transhiatal esophagectomy was accomplished (Fig. 1). The stom- ach was pulled up to the neck and a gastropharyngeal anastomosis was established. The two parathyroid glands were implanted into the sternocleidomastoid muscle. Case 2 A 69-year-old woman presented with a carcinoma of the hypopharynx in®ltrating the upper esophageal sphincter. An esophagolaryngopharyngeal resection was carried out combined with concurrent bilateral neck lymph node resection. Permanent tracheostomy, gastropharyngeal anastomosis, and autotransplanta- tion of the upper two parathyroid bodies were carried out as described for case 1. Both patients had an uneventful recovery. Post- operatively, both patients were given vitamin D 1.0± 20 lg day ±1 and calcium carbonate 1 g day ±1 . Vitamin D, calcium and thyroxine supplementation started on Address correspondence to: N. Arkadopoulos, 14 Komotinis Str., GR-11526 Athens, Greece. Tel: (+30) 1 748 2259; Fax: (+30) 1 620 3565; E-mail: narkado@otenet.gr 314 Diseases of the Esophagus (1999) 12, 314±316 Ó 1999 ISDE/Blackwell Science Asia Downloaded from https://academic.oup.com/dote/article/12/4/314/2194946 by guest on 02 February 2023