Free revascularized jejunal loop repair following total pharyngolaryngectomy for carcinoma of the hypopharynx: Report of 90 patients

Abstract

Ninety patients with carcinoma of the hypopharynx underwent pharyngolaryngectomy and reconstruction with a jejunal free autograft. Fifty-five patients had primary surgery and 35 salvage surgery for recurrence after radiotherapy. Following primary surgery 28 patients had postoperative radiotherapy and 27 did not. Complications occurred in 51 per cent of patients, the most common being necrosis of the jejunal graft (19 per cent); 12 per cent developed significant stenosis and 4 per cent died in the perioperative period. Eleven per cent of patients developed a fistula. The total number of complications diminished as the experience of the unit increased. Median follow-up was 4.9 years. Of patients treated with primary surgery, 48 per cent developed primary site recurrence (at 3 years) and 53 per cent neck node recurrence (at 5 years). The tumour-specific 5-year survival rate for all patients was 42 per cent. Following primary surgery 28 per cent survived for 5 years and after salvage surgery the rate was 59 per cent. Positive resection margins and extensive neck disease adversely affected survival (P = 0.02 and P = 0.001 respectively). The free revascularized jejunal graft is a safe and predictable method of repair following total pharyngolaryngectomy.

A report of 50 patients with carcinoma of the hypopharynx treated by total pharyngolaryngo-oesophagectomy repaired by gastric transposition

“…Only one patient in the present series developed a stenosis and this was in the salvage surgery group. Stenosis is therefore very much less common than in the jejunal loop repair procedure 1 . Speech has not been specifically studied in the present paper but it is known to be relatively poor following gastric transposition.…”

“…For large tumours which have not spread to the cervical oesophagus (i.e. the inferior resection margin is above the clavicles), total pharyngolaryngo‐oesophagectomy and free revascularized jejunal loop is the treatment of choice 1 . If this is not feasible total pharyngolaryngo‐oesophagectomy is carried out and repaired by gastric transposition.…”

“…The incidence in the United Kingdom is approximately 1 per 100 000. The survival for patients with hypopharyngeal cancer is the poorest for any head and neck site 1 whichever method is used to treat it and from whatever unit the treatment results emerge. Even with aggressive treatment, many patients are dead within 1 year of diagnosis 2 …”

“…In head and neck cancer, hypopharyngeal cancer has the dubious reputation of perhaps being the most difficult to treat with a tendency to present late. Aggressive surgical treatment leads to massive loss of function and many complications, with approximately half the patients developing significant problems postoperatively 1 . Surgical excision of the cancer involves extensive resection; therefore, irradiation therapy has been suggested for all patients with small tumours 2 .…”

“…Reconstruction of the pharynx following total pharyngolaryngectomy has always presented a technical challenge. The Department of Otolaryngology – Head and Neck Surgery at the University of Liverpool has recently described its series of 90 total pharyngolaryngectomies with free revascularized jejunal loop repair 1 . This is generally reserved for those patients with tumours that do not involve the cervical oesophagus and do not have extensive skip lesions or any mediastinal disease.…”