Pharyngoesophageal reconstruction after resection of hypopharyngeal carcinoma: a new algorithm after analysis of 142 cases

Abstract

BackgroundThe aim of this study is to define an algorithm for the choice of reconstructive method for defects after laryngo-pharyngo-esophagectomy for hypopharyngeal carcinoma.MethodsOne hundred and forty two cases of hypopharyngeal carcinoma were included and operated on by either partial pharyngectomy, total pharyngectomy or esophagectomy. The reconstructive method was tailored according to the resected segment.ResultsPectoralis flap was used in 48 cases, free jejunal flap in 28 cases, augmented colon bypass in 4 cases, gastric pull up in 32 cases and gastric tube in 30 cases. Mean hospital stay was 12 days. Mortality rate was 10.6% and morbidity rate was 31.7%. Total flap failure occurred in 3 cases of free flap and one case of pectoralis flap. There were 23 cases of early fistula. Late stricture occurred in 19 cases, being highest with myocutaneous flap (early fistula 12/50 and late stricture 13/50).ConclusionFree jejunal flap was the flap of choice for reconstruction when the safety margin is still above the clavicle. In cases with added esophagectomy, we recommend gastric tube as a method of choice for reconstruction.

Application of xenogenic acellular dermal matrix in reconstruction of oncological hypopharyngeal defects

“…3 Electronic laryngoscopic examination of one patient 2 months after surgery, the draft was covered by mucosal like tissue (white arrow) Eur Arch Otorhinolaryngol incidence of pharyngeal fistula ranged from 16.2 to 40 % in flap based reconstruction surgery. Old age, poor tolerance to major operation and severe nutritional deficiencies were ascribed [3,8,15]. The incidence rate of pharyngeal fistula in this study is less than the reported, which would attribute to short operation time, less intraoperative bleeding, proper antibiotic therapy,enteral nutrition and excellent blood circulation derived from thyroid gland.…”

“…Reconstruction of anatomical structure and eating function are challenges for surgeons [2]. Primary closure and flap reconstruction was confirmed to be viable and reliable by prior studies [3]. But primary closure is not feasible when the defects were too big, while the disadvantages of flap are unaesthetic appearance, pain, and infection of the donor site.…”

Revisiting the gastric pull‐up for pharyngoesophageal reconstruction: A systematic review and meta‐analysis of mortality and morbidity

“…(Table I). One of the common variations was tubing of the stomach by resecting the lesser curvature of the stomach [13,[15][16][17][18][19][20][21][22]. Another variation was the use of thoracotomy for dissection of the esophagus [2,23].…”

Management algorithm for failed gastric pull up reconstruction of laryngopharyngectomy defects: Case report and review of the literature

“…As compared to management of anastomotic leaks, where only a portion of the anastomosis has dehisced, fewer studies report on the management of circumferential gastric necrosis following GPU reconstruction of hypopharngeal defects (Tables 1 and 2 ). The reported rate of gastric necrosis after GPU reconstruction of hypopharyngeal defects ranged from 0 % [ 4 , 9 , 17 – 21 ] to 24 % [ 22 ] (Table 1 ). 15 studies reported on both the rate of gastric necrosis and causes of mortality.…”