A.N. Rudyk1–3, E.I. Sigal1, T.L. Sharapov1, E.A. Acel3, A.N. Hisamutdinov1, R.G. Khamidullin1, M.R. Bakirov1, Murad M. Nasrullaev1, A. G. Latypov1
1Republican Clinical Oncological Dispensary named after Prof. M.Z. Sigal, Kazan
2Kazan State Medical Academy – Branch Campus of the FSBEI FPE RMACPE MOH Russia, Kazan
3Kazan (Volga region) Federal University, Kazan
Rudyk A.N. – PhD (Medicine), oncologist of the Oncology Department No. 5 (tumors of head and neck, Acting Head of the Department of Maxillofacial Surgery and Surgical Stomatology, Associate Professor of the Department of Oncology, Radiology and Palliative Medicine, Associate Professor of the Department of Surgical Diseases
Sibirsky tract, 29, 420029, Kazan, Russian Federation, tel.: +7-905-020-21-40, e-mail: anru_onco@inbox.ru, ORCID ID: 0000-0002-7309-9043
Abstract. In modern oncological practice, the impact of comorbid pathology on the clinical manifestations, diagnosis, prognosis and treatment of patients is not always accurately assessed. Reliable scientific analysis and search for existing links is rarely performed, and the results obtained are not always representative.
The study objective is to investigate the effect of comorbidity on complications in patients with cancer of the larynx, hypopharynx and cervical esophagus during laryngopharyngoesophagectomy with restoration of the esophageal tract using a graft from a large curvature of the stomach and various methods of pharyngoprostastomosis formation on the neck.
The average age of men during laryngopharyngoesophagectomy was 7 years greater than that of women: 58.1 (95% CI, 55.2 to 60.6) years, versus 51.8 (95% CI, 48.5 to 55.1) years. The analysis of the age characteristics of the patients highlights the urgency of the problem, since 61% of patients from 41 to 60 years old constitute the working-age population.
Laryngopharyngoesophagectomy is mainly indicated when the tumor is localized in the hypopharynx and cervical esophagus (92.3%). The proportion of patients with the T3 and T4 (advanced) stages of the disease (TNM-7) reaches 92.5%, lymph node damage (N1-N3) is observed in 32.8%.
The incidence of complications in the form of failure of pharyngogastroanastomosis made with the «stapler» method increased in patients of the 41–50 years’ age group, p = 0.048 (< 0.05).
The Charlson Comorbidity Index in the «5 points” and “11–28 points» groups is significantly associated with the failure of pharyngeal gastroanastomosis (FPHA) performed by the «manual method», p = 0.046 and 0.002, respectively. Pharyngogastric anastomosis leakage with the «stapler» technique is statistically associated with the Charlson Comorbidity Index of «11–28 points», that is, with severe comorbid pathology, p = 0.0001.
When choosing the method of anastomosing between the pharynx and stomach, and deciding on surgical intervention of laryngopharyngoesophagectomy, one should take into account a significantly increased risk of complications with severe comorbid pathology, in particular, the Charlson index value of «11–28 points» or more.
Key words: Charlson index, cancer of the larynx, cancer of the hypopharynx, cancer of the cervical esophagus, comorbidity, hardware (stapler, mechanical) anastomosis, manual anastomosis.