Analysis of the methods of pharyngoesophageal reconstruction

Surkin, Marc I.; Lawson, William; Biller, Hugh F.

doi:10.1002/hed.2890060510

Cited by 150 publications

(71 citation statements)

References 84 publications

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“…In case histories, a fi ve year survival of patients with advanced hypopharyngeal malignancy is listed in only 25-35 % of cases (1)(2)(3). In the submitted study, the longest interval of a patient's monitoring was 7.5 years.…”

Section: Discussionmentioning

confidence: 82%

Primary reconstruction of pharyngo-oesophageal defects in oncologic patients

Palenčár

Kroslak²,

Fedeleś³

2013

BLL

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Abstract:Objectives: Majority of patients that undergo total or partial removal of the hypopharynx and cervical oesophagus are oncologic patients. Optimal management of head and neck malignancies requires multimodal therapy including surgical ablation, reconstruction, and adjuvant oncologic therapy. Despite aggressive surgical and adjuvant therapy, a fi ve-year survival rate is achieved only in 25-35 %. Methods: In the presented retrospective study, the choice of reconstructive method was infl uenced by type, length and extent of the defect, and condition of patient. The fl ap was indicated when the defect not allowed for primary suture of the hypopharynx and/or cervical oesophagus. Two-team approach was used. Results: The study was based on the data of ten patients. Radial forearm fl ap was used in 8 cases; pectoralis major myocutaneous fl ap was used in 3 patients, and ALT perforator free fl ap in 1 case. A total of 12 fl aps were used for 10 patients. Two patients developed free fl ap necrosis. These necrotic fl aps were substituted with pedicled pectoralis major myocutaneous fl aps. Conclusions:The primary reconstruction of the pharyngo-oesophageal defects could be the method of choice. For the partial defects, the best choice could be a radial forearm free fl ap. For circumferential defects, jejunal fl ap could be the best. The pectoralis major pedicled fl ap could be a safe procedure for elderly patients with multiple medical problems ( Tab. 6, Fig. 2, Ref. 34). Full Text in PDF www.elis.sk. Key words: pharynx reconstruction, pharyngo-oesophageal reconstruction, ALT perforator fl ap, free radial forearm fl ap, pectoralis major fl ap. Surgical resection of the hypopharynx and cervical oesophagus may lead to severe functional defi cits, and it may prevent the patient's peroral intake of solid food and liquids. This usually applies to patients with locally advanced laryngeal or hypopharyngeal malignancy. The treatment of these patients involves resection and reconstruction followed by radiotherapy. Surgical resection and reconstruction of the hypopharynx in patients suffering from advanced oncological disease is a challenge for surgeons, anaesthesiologists, nurses, and represents serious stress for patient.Resection of a small part of the hypopharynx or cervical oesophagus allows for primary suture of the defect, and it results in only minimal and temporary changes. Extensive resections require diffi cult reconstructions, often associated with free transfer of tissues. Despite the extensive surgical therapy and aggressive adjuvant therapy, fi ve-year survival of patients in stage III or IV of head and neck malignancies is only 25-35 % (1-3).Nowadays, the most favoured method is that of one-stage reconstruction of gastrointestinal tract continuity. The reconstructions of hypopharynx and cervical oesophagus have progressed from multiple-stage procedures using pedicle skin fl aps (4-8) to the use of pedicle fasciocutaneous, myocutaneous and visceral fl aps (9-15). The advent of microsurgical free fl aps has allo...

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Section: Discussionmentioning

confidence: 82%

Primary reconstruction of pharyngo-oesophageal defects in oncologic patients

Palenčár

Kroslak²,

Fedeleś³

2013

BLL

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“…Dentre as complicações que ocorrem nas reconstruções de esôfago, talvez a que mais influencie neste aspecto seja a disfagia, cujas causas podem ser a estenose anastomótica, a recorrência tumoral e a estenose péptica no esôfago remanescente 3 . Uma causa rara de disfagia é a estenose isquêmica, um diagnóstico de exclusão em relação às etiologias previamente mencionadas.…”

Section: Discussionunclassified

O uso do tubo colônico bipediculado microcirúrgico na reconstrução do esôfago

Galvao

Pinto

Sbalchiero

2003

Rev. Col. Bras. Cir.

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Trabalho realizado no Instituto Nacional de Câncer -INCa -RJ INTRODUÇÃOEm algumas situações, a reconstrução esofágica após esofagectomia não pode ser realizada com tubo gástrico. Por exemplo, nos tumores da cárdia com invasão para o estômago proximal, tumores no terço distal do esôfago que invadam a pequena curvatura do estômago e em casos que foram realizadas cirurgias prévias com ressecções gástricas parciais 1 . Nestas condições, preconiza-se a utilização do cólon.Como complicações desta cirurgia podemos citar o alto índice de fistulas das anastomoses na região do esôfago cervical, assim como estenoses por isquemia 2 . No caso apresentado, com o objetivo de melhorar a perfusão e evitar tais complicações, utilizamos um segundo pedículo vascular na parte distal deste tubo colônico através da anastomose microcirúrgica, funcionando como um "super-charge". RELATO DO CASOPaciente de 52 anos, masculino, negro, com carcinoma epidermóide do terço médio do esôfago, submetido a esofagectomia total e reconstrução com transposição gástrica. No quarto dia de pós-operatório apresentou necrose do segmento gástrico proximal tendo sido realizada a retirada do estômago e confecção de esofagostomia e jejunostomia. Após quatro meses, foi submetido a nova reconstrução com transposição colônica bipediculada, com anastomose microcirúrgica. Foi utilizado segmento colônico de 40 cm (transverso e descendente) com ligadura da artéria mesentérica inferior, mantendo-se a vascularização pela artéria cólica média e drenagem com as veias comitantes (Figura 1). O tubo colônico foi posicionado no sentido anisoperistáltico retroesternal e a anastomose microcirúrgica ("super-charge") foi realizada entre os vasos hemorroidários superiores e artéria e veia cervical transversa de forma término-terminal, utilizando fios oito e nove zeros, respectivamente (Figura 2). A evolução pós-operatória transcorreu sem anormalidades. Após exame contrastado no 10º dia pós-operatório, afastou-se a possibilidade de fístula e o paciente apresentou boa reabilitação funcional e deglutição normal, com recuperação do estado nutricional.

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“…Historically, reconstruction of the hypopharynx and cervical esophagus has always been a challenge [15]. An analysis of the usual method [6]utilized for reconstruction reports a 10% overall mortality and a 61% complication rate.…”

Section: Discussionmentioning

confidence: 99%

The Lateral Island Trapezius Myocutaneous Flap for Circumferential Reconstruction of Hypopharynx and Cervical Esophagus

Castillo

Peoples²,

Machicao³

et al. 2001

Dig Surg

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The lateral island trapezius was utilized for reconstruction of hypopharyngeal and cervical esophagus defects in high-risk patients, avoiding entry into the celomic cavities as an approach to decrease morbidity and mortality. Seven male patients were treated at the State University of New York between 1988 and 1991 and underwent reconstruction with the lateral island trapezius flap. There was no mortality, 2 patients developed pharyngocutaneous fistulas; 1 patient operated after radiation treatment failure remained with positive margins at resection but his fistula never healed, and another patient underwent a minor revision with successful closure of the fistula. All patients regained swallowing and none required dilatations. The preferred methods of reconstruction for the reasonable risk patient are gastric pull-up and free jejunal transfer; both of which require entry into cavities. The lateral island is a reliable alternate method of reconstruction for high-risk patients in whom intracavitary surgery may lead to unacceptably high morbidity and mortality. When the vascular anatomy is not favorable, rerouting of the vessels may be required utilizing microvascular reconstruction. The donor site defect is closed primarily or skin grafted, and subsequent functional limitations are minimal and well tolerated.

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Analysis of the methods of pharyngoesophageal reconstruction

Cited by 150 publications

References 84 publications

Primary reconstruction of pharyngo-oesophageal defects in oncologic patients

Primary reconstruction of pharyngo-oesophageal defects in oncologic patients

O uso do tubo colônico bipediculado microcirúrgico na reconstrução do esôfago

The Lateral Island Trapezius Myocutaneous Flap for Circumferential Reconstruction of Hypopharynx and Cervical Esophagus

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