• 12/24/2004
  • Calcutta, India
  • The Telegraph

S.K. Ladla was having difficulty in swallowing and his voice had become hoarse. The doctors diagnosed the 65-year-old to be suffering from laryngo pharynx cancer — the most common variety of cancer among males in the city.

In the past, such patients had no option but to go in for radiotherapy, as surgery was not possible. But not any more. Doctors at Advanced Research and Medicare Institute removed Ladla’s larynx and pharynx, and reconstructed his foodpipe with a free flap from the forearm.

Indirect laryngoscopic examinations had earlier revealed a large growth involving the larynx, pharynx, respiratory pipe and the foodpipe. The cancer was detected after direct laryngoscopic biopsy, and a CT scan found that it was locally advanced, affecting both pipes.

“Since the cancer was locally advanced, we had to remove both the pipes. Through micro-vascular reconstruction, pharynx was repaired and the patient is doing well,” said oncologist Subhankar Deb, who along with a team of other doctors, performed the 10-hour surgery.

The carotid artery and internal jugular vein of the neck was rejoined with the vein and artery of the flap, thus maintaining nutrition and blood supply to it. “Had there not been such a reconstruction, the flap would not have survived,” Deb said. Tracheotomy was done to enable the patient to breathe.

“We had planned to reconstruct the pharynx with a flap from the intestine. Since a wall of the pharynx could be retained, the flap was taken from the forearm and the 12-cm gap was filled up by micro-vascular reconstructive surgery,” said surgeon Anupam Golash, who was part of the operating team.

“Earlier, if the larynx was affected, tracheotomy was conducted after removing the respiratory pipe. But when both the pharynx and larynx were affected, radiotherapy was the only option,” Deb said.

“This is not a common surgical method and requires good doctors and back-up infrastructure,” said oncologist Subir Ganguly, former head of the radiotherapy department of Medical College and Hospital. He was, however, of the opinion that radiotherapy and surgery are equally effective.

“One out of three male cancer patients suffer from head and neck cancer and this is mainly due to smoking,” Ganguly said.