Primary reconstruction of pharyngo-oesophageal defects in oncologic patients

Abstract

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...