Pharyngoesophageal diverticulum complicated by squamous cell carcinoma

Systematic review of carcinoma arising in pharyngeal diverticula: a 112-year analysis

BACKGROUND

Carcinoma is a rare complication of pharyngeal diverticula. There is a paucity of information about its incidence, presentation, management, and treatment outcomes. A systematic review and analysis of all reported cases has been carried out.

METHODS

A comprehensive literature search for pharyngeal diverticula carcinoma was performed from 1896 to 2008. Descriptive analyses were carried out by analyzing the absolute and relative frequencies. Comparison of groups was illustrated with Kaplan-Meier curves and tested statistically using the log-rank test. A cohort of 56 patients with benign pharyngeal diverticula was selected for comparison with the accumulated cohort of pharyngeal diverticula carcinoma, and a Fisher's exact test was carried out on the extracted clinical characteristics of this cohort to evaluate for differences between benign and malignant pharyngeal diverticula.

RESULTS

Forty-three articles reporting 60 cases satisfied the inclusion criteria. The mean age at presentation was 68.8 years (SD = 9.8 years). Five-year cancer-specific survival (CSS) rates for patients who underwent excision alone, excision + postoperative radiotherapy (PORT), and radiotherapy alone were 0.74 versus 0.63 versus 0.0, respectively (p = .39). Five-year CSS rates of patients <65 versus ≥65 years were 0.43 versus 0.78, respectively (p = .046).

CONCLUSION

Irregular symptoms in benign diverticula should raise suspicion of malignancy. Management consists of surgical excision ± PORT. © 2014 Wiley Periodicals, Inc. Head Neck 36: 1368-1375, 2014.

Esophageal diverticula and cancer

Esophageal diverticula are rare. The association of cancer and diverticula has been described. Some authors adopt a conservative non-surgical approach in selected patients with diverticula whereas others treat the symptoms by diverticulopexy or myotomy only, leaving the diverticulum in situ. However, the risk of malignant degeneration should be may be taken in account if the diverticulum is not resected. The correct evaluation of the possible risk factors for malignancy may help in the decision making process. We performed a literature review of esophageal diverticula and cancer. The incidence of cancer in a diverticulum is 0.3-7, 1.8, and 0.6% for pharyngoesophageal, midesophageal, and epiphrenic diverticula, respectively. Symptoms may mimic those of the diverticulum or underlying motor disorder. Progressive dysphagia, unintentional weight loss, the presence of blood in the regurgitated material, regurgitation of peaces of the tumor, odynophagia, melena, hemathemesis, and hemoptysis are key symptoms. Risk factors for malignancy are old age, male gender, long-standing history, and larger diverticula. A carcinoma may develop in treated diverticula, even after resection. Outcomes are usually quoted as dismal because of a delayed diagnosis but several cases of superficial carcinoma have been described. The treatment follows the same principals as the therapy for esophageal cancer; however, diverticulectomy is enough in cases of superficial carcinomas. Patients must be carefully evaluated before therapy and a long-term follow-up is advisable.

Outcome analysis of Zenker's diverticulectomy and cricopharyngeal myotomy

BACKGROUND

The optimal management of Zenker's diverticula is controversial in part because of the method of categorizing treatment success or failure. Subjective and objective radiologic tests have been used to evaluate the various treatment modalities. There seems to be poor correlation between subjective and objective findings, and we tested this hypothesis in a group of patients undergoing one form of therapy (diverticulectomy and cricopharyngeal myotomy [CPM]).

METHODS

Eighteen consecutive patients underwent Zenker's diverticulectomy and CPM. Postoperative symptoms and abnormalities detected by barium esophagrams were evaluated after a mean follow-up of 30.3 months (range, 7-74 months).

RESULTS

Three of 18 patients (17%) complained of dysphagia (2 occasional and not bothersome; 1 bothersome and affecting dietary intake). Postoperative static contrast esophagrams were interpreted without knowledge of the subjective symptoms. Small diverticula were identified in 8 patients (44%). There was poor correlation between symptoms and objective radiographic abnormalities with agreement of 56% and a kappa statistic of 0.23.

CONCLUSIONS

Objective radiographic abnormalities are far more common than subjective complaints following diverticulectomy and CPM. Postoperative static contrast radiography is not routinely required and may be misleading because of the poor correlation between symptoms and radiographic findings. The value of dynamic videofluoroscopy needs to be evaluated.

Pharyngeal pouch carcinoma: two unusual cases

Two patients with carcinomata arising in pharyngeal pouches are reported. In one, the tumour was detected preoperatively by a contrast radiographic study. In the second the lesion was a carcinoma in situ. The English literature is reviewed with reference to these two unusual features.