Microsurgical reconstruction of pharyngoesophageal defects—case series and critical review of the literature
The reconstructive goals after laryngopharyngoesophagectomy are the reestablishment of the digestive conduit, achievement of adequate swallowing, and voice restoration. The pharyngoesophageal segment is typically reconstructed with a jejunal or a fasciocutaneous free flap. The gastro-omental free flap offers unique advantages in high-risk surgical fields. The best reconstructive option is still a matter of controversy. A retrospective study was conducted to assess the morbidity and functional results of microsurgical pharyngoesophageal reconstructions performed at our institution in the last 16 years and compare them with the literature.
A retrospective review was conducted on patients who underwent pharyngoesophageal microsurgical reconstruction between 1999 and 2016 at a single institution. The perioperative morbidity, mortality, and functional outcomes were evaluated and compared with similar published case series.
A total of 14 free flap reconstructions were performed, after pharyngolaryngoesophagectomy or pharyngoesophageal radionecrosis. Patients received jejunal, radial forearm, gastro-omental, or anterolateral thigh flaps. There was one flap failure and one perioperative death. The rates of stricture and fistula were 8.3 and 16.7%, respectively. Oral diet was achieved in all patients and 71% have been considered to have an intelligible speech. At 1-year post-op, 71.4% of the patients were alive and the 3-year survival rate was 35.7%.
The reconstruction of the pharyngoesophageal segment requires safe, reliable, and functional single-stage solutions. Fasciocutaneous flaps seem to provide better functional results and allow a shorter hospital stay, while enteric flaps appear to be more reliable in adverse surgical fields.
Level of Evidence: Level IV, therapeutic study.
KeywordsPharyngoesophageal reconstruction Gastro-omental flap Salvage pharyngolaryngoesophagectomy Esophagus radionecrosis Jejunal flap Fasciocutaneous flaps
Compliance with ethical standards
This study did not receive any funding.
Conflict of interest
Sara Cunha, Horácio Zenha, Diana Santos, Carolina Andresen, Tiago Guedes, Antónia Póvoa, Susana Graça, Carlos Soares, Jorge Maciel, and Horácio Costa declare that they have no conflict of interest.
For this type of study, formal consent from an ethics committee is not required.
Informed consent was obtained from all individual participants included in the study.
Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.
- 3.Mikulicz J (1886) Ein Fall von Resection des Carcinomatosen Esophagus mit Plastischem Ersatz des Excidirten Stuckes. Prag Med Wchnschr 2:93Google Scholar
- 5.Wookey H (1942) The surgical treatment of carcinoma of the pharynx and upper esophagus. Surg Gynecol Obstet 75:499Google Scholar
- 12.Baudet J (1979) Reconstruction of the pharyngeal wall by free transfer of the greater omentum and stomach. Int J Microsurg 1:53–59Google Scholar
- 17.Shangold LM, Urken ML, Lawson W (1991) Jejunal transplantation for pharyngoesophageal reconstruction. Otolaryngol Clin N am 24:1321–1342Google Scholar
- 20.Viñals JMV, Rodrigues TA et al (2014) Outcomes of gastro-omental free flap reconstruction of salvage laryngopharyngectomy for pharyngeal and laryngeal cancer after concurrent chemoradiotherapy. Ann Plast Surg. doi: 10.1097/SAP.0000000000000298
- 22.Clark JR, Gilbert R, Irish J, Brown D, Neligan P, Gullane PJ (2006) Morbidity after flap reconstruction of hypopharyngeal defects. Laryngoscope. doi: 10.1097/01.mlg.0000191459.40059.fd