Abstract
This study aimed to evaluate the operative outcomes of using gastric pull-up (GPU), pectoralis major myocutaneous flap (PMMF), and jejunal free flap (JFF) to reconstruct the hypopharynx after resection of hypopharyngeal and cervical esophageal carcinoma. Retrospective clinical study. Otolaryngology Department, Zagazig University Hospital, Egypt and Surgical Department, National Cancer Institute, Cairo, Egypt. Records of 104 patients who underwent resection of carcinoma of the hypopharynx and cervical esophagus were reviewed to determine the indications for radical resection, location, and stage of the primary tumor, gross and pathological surgical resection margins, operative complications, morbidity, and mortality. Reconstruction was performed using the GPU for group (1) (n = 33), PMMF for group (2) (n = 34), and JFF for group (3) (n = 37). The hypopharynx was the most common primary tumor site for group (2) and group (3) whereas group (1) had lesions more frequently in the cervical esophagus. The overall postoperative morbidity rate was 20.2 % with a perioperative mortality rate of 6.7 % and there was no significant difference between the three groups. There was no graft necrosis in group (1) compared to 5.9 % in group (2) and 5.4 % in group (3). Pulmonary complications occurred commonly (30.3 %) in group (1) compared to 11.8 % in group (2) and 10.8 % in group (3) The overall 3 years survival rate was 67.3 % and there was no significant difference between the three groups. The outcomes of the three techniques are equally successful when used appropriately. The nature of the defect indicates the method of reconstruction. For short reconstruction above the thoracic inlet, PMMF or JFF are equally effective and in tumors requiring total esophagectomy, GPA is indicated.
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References
Lefebvre JL, Chevalier D, Coche-Dequeant B (2003) Cancer of the hypopharynx and cervical esophagus. In: Myers EN, Suen JY, Myers JN, Hanna EY (eds) Cancer of the head and neck, 4th edn. WB Saunders, Philadelphia, pp 379–390
Peracchia A, Bonavina L, Botturi M et al (2001) Current status of surgery for carcinoma of the hypopharynx and cervical esophagus. Dis Esophagus 14:95–97
Harrison DF, Thompson AE (1986) Pharyngolaryngoesophagectomy with pharyngogastric anastomosis for cancer of the hypopharynx. Review of 101 operations. Head Neck Surg 8:418–428
Baek SM, Lawson W, Biller HF (1981) Reconstruction of hypopharynx and cervical esophagus with pectoralis major island myocutaneous flap. Ann Plast Surg 7:18–24
Shirakawa Y, Naomoto Y, Noma K et al (2004) Free jejunal graft hypopharyngeal and esophageal reconstruction. Langenbecks Arch Surg 389:387–390
American Joint Committee on Cancer (1983) Manual for staging of cancer, 2nd edn. JB Lippincott, Philadelphia
Wurtz A, Chastanet P (1988) Carcinomes malpighiens de L’oesophage thoracique. Quell classification tomodensito-metrique. Gastroenterol Clin Biol 12:921–925
Peracchia A, Bardini R, Ruol A et al (1990) Surgical management of carcinoma of the hypopharynx and cervical esophagus. Hepatogastroenterology 37:371–375
McCarthy CM, Kraus DH, Cordeiro PG (2005) Tracheostomal and cervical esophageal reconstruction with combined deltopectoral flap and microvascular free jejunal transfer after central neck exentration. Plast Reconstr Surg 115:1304–1310
Triboulet JP, Mariette C, Chevalier D, Amrouni H (2001) Surgical management of carcinoma of the hypopharynx and cervical esophagus: analysis of 209 cases. Arch Surg 136:1164–1170
Podrecca S, Salvatori P, Squadrelli SM (2006) Review of 346 patients with free-flap reconstruction following head and neck surgery for neoplasm. J Plast Reconstr Aesthet Surg 59:122–129
Asciot AJ, Hofstetter WL, Miller MJ et al (2005) Long-segment, supercharged, pedicled jejunal flap for total esophageal reconstruction. J Thorac Cardiovasc Surg 130:1391–1398
Takushima A, Momosawa A, Asato H et al (2005) Double vascular pedicled free jejunum transfer for total esophageal reconstruction. J Reconstr Microsurg 21:5–10
Smith DP, Wagels M, Theile DR (2013) Jejunal free flap reconstruction of the pharyngolaryngectomy defect: 368 consecutive cases. J Plast Reconstr Aesth Surg 66:9–15
Shah JP, Haribhakti V, Loree TR, Sutaria P (1990) Complications of the pectoralis major myocutaneous flap in head and neck reconstruction. Am J Surg 160:352–355
LeQuesne LP, Ranger D (1966) Pharyngolaryngectomy with immediate pharyngogastric anastomosis. Br J Surg 53:105–109
Silver CE (1976) Gastric pull-up operation for replacement of the cervical portion of the esophagus. Surg Gynecol Obstet 142:243–245
Orringer MB (1984) Technical aids in performing trans-hiatal esophagectomy without thoracotomy. Ann Thorac Surg 38:128–132
Spiro RH, bains MS, Shah JP, Strong EW (1991) Gastric transposition for head and neck cancer: a critical update. Am J Surg 162:348–351
Bardini R, Ruol A, Peracchia A (1995) Therapeutic options for cancer of the hypopharynx and cervical esophagus. Ann Chir Gynecol 84:202–207
Lam KH, Wong J, Lim ST, Ong GB (1981) Pharyngogastric anastomosis following pharyngolaryngoesophagectomy. Analysis of 157 cases. World J Surg 5:509–516
Gourin GG, Terris DJ (2004) carcinoma of the hypopharynx. Surg Oncol Clin N Am 13:81–98
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Elfeky, A.E., Nasr, W.F., Khazbak, A. et al. Hypopharyngeal reconstruction: a comparison of three alternatives. Eur Arch Otorhinolaryngol 272, 3045–3050 (2015). https://doi.org/10.1007/s00405-014-3306-x
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DOI: https://doi.org/10.1007/s00405-014-3306-x