A UNIQUE SURGERY THAT RESTORED VOICE AND THE ABILITY TO EAT NATURALLY

The courage and persistence of this patient from Tver is truly admirable. In December of last year, Galina started having difficulty swallowing. As a professional teacher, she was familiar with voice and throat problems, since they are her working “tools.” An ENT doctor in her hometown prescribed conservative therapy, but the treatment didn’t help.

The woman sought help at a regional hospital, where a cyst on her right tonsil was removed. However, the swallowing and eating issues persisted. The search for the cause continued. An endoscopic examination finally revealed the reason: a tumor in the laryngopharynx.

By the time of diagnosis, the tumor had already spread to her larynx and cervical esophagus. At the regional oncology center, Galina was advised to consult the Federal State Budgetary Institution of the “National Medical Research Radiological Centre” of the Ministry of Health of the Russian Federation. Given the tumor’s location, the risk of losing her voice and no longer being able to eat independently was extremely high.

The oncology council at the national center made the only possible decision that offered a chance to remove the tumor and preserve her quality of life: surgery with the reconstruction of the removed part of the laryngopharynx and esophagus.

“Three teams participated in the surgery: head and neck tumor specialists, abdominal surgeons, and anesthesiologists,” explains Mikhail Ratushny, head of the head and neck microsurgery department at the P. Hertsen Moscow Oncology Research Institute – branch of the Federal State Budgetary Institution of the “National Medical Research Radiological Centre” of the Ministry of Health of the Russian Federation. “The tumor blocked both the esophageal and respiratory tracts. Therefore, during the surgery, we removed the larynx, the laryngopharynx, and the cervical esophagus, as well as the cervical lymph nodes. To restore the lost functions, a microsurgical reconstruction of the respiratory and esophageal tracts was required, using the patient’s own tissues—parts of the small and large intestines.”

Colleagues from the Center for Abdominal Surgery at the P. Hertsen Moscow Oncology Research Institute assisted in forming the plastic material in the abdominal cavity. The material was moved to the neck. One of the most challenging stages of the operation followed—the microsurgical phase: under a microscope, surgeons restored blood circulation in the autograft by connecting its vessels to the blood vessels in the neck. The esophageal pathway between the mouth and esophagus was formed using a fragment of the large intestine, and a tracheoesophageal shunt for voice formation was created using a fragment of the small intestine. The presence of a special valve between the small and large intestines in the autograft will prevent food particles from entering the trachea when swallowing in the future.

The surgery, which also involved Alexey Troitsky and Irina Novikova, not only removed the malignant tumor but also included a simultaneous reconstructive stage aimed at restoring natural feeding and forming a voice without a larynx.

The operation lasted about six hours and proceeded without complications. Now, Galina will undergo postoperative rehabilitation with a speech therapist at our Center. The therapist will teach her the necessary skills for using her new voice apparatus. The most frightening part of our heroine’s journey is now behind her.