Skip to main content
SpringerLink
Log in

Total laryngopharyngectomy with circumferential reconstruction: Helsinki institutional study

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Surgical complications after total laryngopharyngectomy (TLP) are common, reconstruction is challenging, and patients often lose their ability to swallow and speak. To evaluate these aspects, we analysed outcome after TLP.

Methods

We reviewed all patients who underwent TLP and subsequent circumferential pharyngeal reconstruction through 2004–2017 at the Helsinki University Hospital.

Results

For the 26 eligible patients, TLP was the primary treatment for 11 and salvage surgery for 15, followed by reconstruction with free flaps in 22 patients and pedicled flaps in 4. An early (≤ 30 days) pharyngocutaneous fistula developed in seven patients (27%; median time 13 days; range 6–26), and a late (> 30 days) fistula in five patients (19%; median time 370 days; range 46–785). In addition, ten patients (39%) developed an oesophageal stricture. Four patients (15%) resumed full oral feeding. A speech prosthesis was inserted for 15 patients (58%) and most of them could produce intelligible speech. We found acceptable survival figures for patients undergoing TLP both as a primary treatment and as salvage procedure: the overall survival at 1 year was 82% and 67%, and at 5 years 33% and 27%, respectively. Disease-specific survival at 1 year was 90% and 70%, and that at 5 years was 45% and 43%, respectively.

Conclusions

Despite fair survival, TLP carries a high risk for postoperative complications with limited functional outcome, thus necessitating cautious patient selection and surgical experience.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Sharaf B, Xue A, Solari A, Boa O, Liu J, Hanasono MM et al (2017) Optimizing outcomes in pharyngoesophageal reconstruction and neck resurfacing: 10-year experience of 294 cases. Plast Reconstr Surg 139(1):105–119. https://doi.org/10.1097/PRS.0000000000002915

    Article  CAS  Google Scholar 

  2. Chen WF, Chang KP, Chen Ch, Shyu VB, Kao HK (2013) Outcomes of anterolateral thigh flap reconstruction for salvage laryngopharyngectomy for hypopharyngeal cancer after concurrent chemoradiotherapy. PLoS ONE 8(1):e53985. https://doi.org/10.1371/journal.pone.0053985

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Keereweer S, de Wilt JHW, Sewnaik A, Meeuwis CA, Tilanus HW, Kerrebijn JDF (2010) Early and long-term morbidity after total laryngopharyngectomy. Eur Arch Otorhinolaryngol 267(9):1437–1444. https://doi.org/10.1007/s00405-010-1244-9

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cooney TR, Poulsen MG (1999) Is routine follow-up useful after combined modality therapy for advanced head and neck cancer? Arch Otolaryngol Head Neck Surg 125:379–382. https://doi.org/10.1001/archotol.125.4.379

    Article  CAS  PubMed  Google Scholar 

  5. Nouraei SAR, Dias A, Kanona H, Vokes D, O’Flynn P, Clarke PM et al (2017) Impact of the method and success of pharyngeal reconstruction on the outcome of treating laryngeal and hypopharyngeal cancers with pharyngolaryngectomy: a national analysis. J Plast Reconstr Aesthet Surg 70(5):628–638. https://doi.org/10.1016/j.bjps.2016.12.009

    Article  CAS  PubMed  Google Scholar 

  6. Parmar S, Al Asaadi Z, Martin T, Jennings C, Pracy P (2014) The anterolateral fasciocutaneous thigh flap for circumferential pharyngeal defects—can it really replace the jejunum? Br J Oral Maxillofac Surg 52(3):247–250. https://doi.org/10.1016/j.bjoms.2013.12.008

    Article  CAS  PubMed  Google Scholar 

  7. Chepeha DB (2018) Salvage laryngectomy and laryngopharyngectomy: A multicenter review of outcomes associated with a reconstructive approach Microvascular Committee of the American Academy of Otolaryngology-Head and Neck Surgery. Head Neck 1–14. https://doi.org/10.1002/hed.25192

  8. Parzefall T, Wolf A, Czeiger S, Frei K, Formanek M, Erovic BM (2016) Effect of postoperative use of diclofenac on pharyngocutaneous fistula development after primary total laryngopharyngectomy: results of a single-center retrospective study. Head Neck 38(Suppl 1):E1515–E1520. https://doi.org/10.1002/hed.24271

    Article  PubMed  Google Scholar 

  9. Chu PY, Chang SY (2009) Reconstruction of the hypopharynx after surgical treatment of squamous cell carcinoma. J Chin Med Assoc 72(7):351–355. https://doi.org/10.1016/S17264901(09)70386-7

    Article  PubMed  Google Scholar 

  10. Perez-Smith D, Wagels M, Theile DR (2013) Jejunal free flap reconstruction of the pharyngolaryngectomy defects: 368 Consecutive cases. J Plast Reconstr Aesthet Surg 66(1):9–15. https://doi.org/10.1016/j.bjps.2012.08.033

    Article  PubMed  Google Scholar 

  11. Van Brederode TD, Halmos GB, Stenekes MW (2017) Functional outcome after one-stage flap reconstruction of hypopharynx following tumor ablation. Eur Arch Otorhinolaryngol 274(2):969–976. https://doi.org/10.1007/s00405-016-4279-8

    Article  PubMed  Google Scholar 

  12. Zelken JA, Kang CJ, Huang SF, Liao CT, Tsao CK (2015) Refinements in flap design and inset for pharyngoesophageal reconstruction with free thigh flaps. Microsurgery 37(2):112–118. https://doi.org/10.1002/micr.22432

    Article  PubMed  Google Scholar 

  13. Sagar B, Marres HA, Hartman EH (2010) Hypopharyngeal reconstruction with an anterolateral thigh flap after laryngopharyngeal resection: results of a retrospective study on 20 patients. J Plast Reconstr Aesthet Surg 63(6):970–975. https://doi.org/10.1016/j.bjps.2009.04.019

    Article  PubMed  Google Scholar 

  14. Clark JR, de Almeida J, Gilbert R, Irish J, Brown D, Neligan P, Gullane PJ (2006) Primary and salvage (hypo)pharyngectomy: analysis and outcome. Head Neck 28(8):671–677. https://doi.org/10.1002/hed.20428

    Article  PubMed  Google Scholar 

  15. Huang TC, Hsu YC, Chen HC, Chang SC, Chen HH (2015) Functional outcome analysis after anterolateral thigh flap reconstruction of pharyngoesophageal defect. Ann Plast Surg 75(2):174–179. https://doi.org/10.1097/SAP.0000000000000073

    Article  CAS  PubMed  Google Scholar 

  16. Piazza C, Taglietti V, Nicolai P (2012) Reconstructive options after total laryngectomy with subtotal or circumferential hypopharyngectomy and cervical esophagectomy. Curr Opin Otolaryngol Head Neck Surg 20(2):77–88. https://doi.org/10.1097/MOO.0b013e328350a5cc

    Article  PubMed  Google Scholar 

  17. Sharp DA, Theile DR, Cook R, Coman WB (2010) Long-term functional speech and swallowing outcomes following pharyngolaryngectomy with free jejunal flap reconstructions. Ann Plast Surg 64(6):743–746. https://doi.org/10.1097/SAP.0b013e3181af3019

    Article  CAS  PubMed  Google Scholar 

  18. Yu P, Hanasono MM, Skoracki RJ, Baumann DP, Lewin JS, Weber RS et al (2010) Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy. Cancer 116(7):1718–1724. https://doi.org/10.1002/cncr.24947

    Article  PubMed  Google Scholar 

  19. Ghazali N, Hanna TC, Dyalram D, Lubek JE (2016) The value of the “Papillon” anterolateral thigh flap for total pharyngolaryngectomy reconstruction: a retrospective case series. J Oral Maxillofac Surg 74(2):406–414. https://doi.org/10.1016/j.joms.2015.09.010

    Article  PubMed  Google Scholar 

  20. Spyropoulou GA, Lin PY, Chien CY, Kuo YR, Jeng SF (2011) Reconstruction of the hypopharynx with the anterolateral thigh flap: defect classification, method, tips, and outcomes. Plast Reconstr Surg 127(1):161–172. https://doi.org/10.1097/PRS.0b013e3181f95997

    Article  CAS  PubMed  Google Scholar 

  21. Piazza C, Del Bon F, Paderno A, Grammatica A, Montalto N, Taglietti V et al (2017) Fasciocutaneous free flap for reconstruction of hypopharyngeal defects. Laryngoscope 127(12):2731–2737. https://doi.org/10.1002/lary.26705

    Article  PubMed  Google Scholar 

  22. Yu P, Robb GL (2005) Pharyngoesophageal reconstruction with the anterolateral thigh flap: a clinical and functional outcomes study. Plast Reconstr Surg 116(7):1845–1855. https://doi.org/10.1097/01.prs.0000191179.58054.80

    Article  CAS  PubMed  Google Scholar 

  23. Scharpf J, Esclamado RM (2002) Reconstruction with radial forearm flaps after ablative surgery for hypopharyngeal cancer. Head Neck 25:261–266. https://doi.org/10.1002/hed.10197

    Article  Google Scholar 

  24. Yu P (2004) Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstructions. Head Neck 26(9):759–769. https://doi.org/10.1002/hed.20050

    Article  PubMed  Google Scholar 

  25. Yu P, Lewin JS, Reece GP, Robb GL (2006) Comparison of clinical and functional outcomes and hospital costs following pharyngoesophageal reconstruction with the anterolateral thigh free flap versus the jejunal flap. Plast Reconstr Surg 117(3):968–974. https://doi.org/10.1097/01.prs.0000200622.13312.d3

    Article  CAS  PubMed  Google Scholar 

  26. Lewin JS, Barringer DA, May AH, Gillenwater AM, Arnold KA, Roberts DB (2006) Functional outcomes after laryngopharyngectomy with anterolateral thigh flap reconstruction. Head Neck 28(2):142–149. https://doi.org/10.1002/hed.20308

    Article  PubMed  Google Scholar 

  27. Chan YW, Ng RW, Liu LH, Chung HP, Wei WI (2011) Reconstruction of circumferential pharyngeal defects after tumor resection: reference or preference. J Plast Reconstr Aesthet Surg 64(8):1022–1028. https://doi.org/10.1016/j.bjps.2011.03.021

    Article  PubMed  Google Scholar 

  28. Murray DJ, Gilbert RW, Vesely MJ, Novak CB, Zaitlin-Gencher S, Clark JR (2007) Functional outcome and donor site morbidity following circumferential pharyngoesophageal reconstruction using an anterolateral thigh flap and salivary bypass tube. Head Neck 29(2):147–154. https://doi.org/10.1002/hed.20489

    Article  PubMed  Google Scholar 

  29. Murray DJ, Novak CB, Neligan PC (2008) Fasciocutaneous free flaps in pharyngolaryngo-oesophageal reconstruction: a critical review of the literature. J Plast Reconstr Aesthet Surg 61(10):1148–1156. https://doi.org/10.1016/j.bjps.2007.09.030

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by the Helsinki University Hospital Research Funds.

Funding

This study was supported by the Helsinki University Hospital Research Fund.

Author information

Author notes

  1. Patrik Lassus and Harri Keski-Säntti have contributed equally to this work.

Authors and Affiliations

  1. Department of Hand and Plastic Surgery, Microsurgery Centre of Latvia, Riga, Latvia

    Janis Zarins

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

    Katri Aro, Leif Bäck, Timo Atula & Harri Keski-Säntti

  3. Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

    Jyrki Vuola & Patrik Lassus

Authors
  1. Janis Zarins
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katri Aro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leif Bäck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Timo Atula
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jyrki Vuola
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patrik Lassus
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Harri Keski-Säntti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Janis Zarins.

Ethics declarations

Conflict of interest

None of the authors have a personal conflict of interest to declare.

Ethical approval

This article does not contain any studies with human or animal participants performed by any of the authors. This research involved only patient charts. For this type of study, formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zarins, J., Aro, K., Bäck, L. et al. Total laryngopharyngectomy with circumferential reconstruction: Helsinki institutional study. Eur Arch Otorhinolaryngol 276, 2577–2584 (2019). https://doi.org/10.1007/s00405-019-05526-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-019-05526-1

Keywords

Search

Navigation