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Aim of the Study: To elucidate hospital mortality, morbidity and actuarial survival rates of patients with carcinoma of the hypopharynx and cervical oesophagus and to identify the technique of choice for reconstruction after pharyngolaryngectomy., Patients and Methods: We reviewed the records of 209 patients who underwent total pharyngolaryngectomy between May 1982 and January 2000. The majority of patients had advanced cancer: hypopharyngeal in 131 cases and cervical oesophageal in 78 cases. Follow-up was complete for all patients. Chi 2 and log rank tests were used, with a limit of significance of 5%., Results: The postoperative mortality and morbidity rates were 4.8% and 38.3%, respectively. Alimentary continuity was achieved using the stomach (127 patients), colon (5 patients), or free jejunal autograft (77 patients). The 1-year and 5-year survival rates were 62% and 24%, respectively. There was no significant difference with regard to the survival between gastric transposition and free jejunal autograft, but there were fewer complications in the gastric pull-up group with regard to the respiratory complications (33% vs 47.0%, p < 0.05), local recurrences (15.8% vs 33.8%, p = 0.004) and survival without dysphagia (76% vs 89%, p < 10(-5))., Conclusion: Surgical ablation is a viable option for advanced hypopharyngeal and cervical oesophageal neoplasms, and stomach interposition is the preferred method of reconstruction.

Gynecomastia is the commonest breast lesion in males. Fifty-two patients (mean age 24 years) operated in our department were reviewed with a mean follow-up of two years and a half. Gynecomastia occurred most frequently during puberty (63%), was bilateral (75%) and idiopathic (65%). The size of the enlargement was evaluated according to Simon's-classification based on breast-volume and skin-redundancy. 18 stage 1, 22 stage 2A, 9 stage 2B, 3 stage 3. Clinical examination and mammography determined the consistency of gynecomastia: adipose or firm. 4 different surgical managements were used: 32 subcutaneous mastectomies, 12 liposuctions, 6 liposuctions assocaited with subcutaneous mastectomy, 1 total mastectomy. One patient had liposuction on one side and subcutaneous mastectomy on the other one. All techniques gave good morphologic results. Nonetheless, the authors recommend the combination "liposuction and subcutaneous mastectomy", as this technique presents many advantages: small intraoperative blood loss, good skin redraping, short hospital stay, complete histologic examination of the material removed.

57 patients with cancer of the hypopharynx underwent 59 pharyngo-esophageal reconstructions with a free jejunal graft after total removal of a tumor combined with resection of the circumferential tissues. 18 patients had been previously irradiated. Median resumption of oral intake was 16 days; 40 out of 50 patients (98%) followed for more than 2 years regained normal eating habits. The cumulative 5-year survival rate was 44%. The free jejunal graft should be advocated as a safe and reliable procedure for hypopharyngeal cancer.