Feedback

Reconstruction After Pharyngolaryngectomy

Juan Carlos Molina, MD, Lorenzo Ferri, MD, PhD
Reconstruction After Pharyngolaryngectomy is a topic covered in the Pearson's General Thoracic.

To view the entire topic, please or .

STS Cardiothoracic Surgery E-Book from The Society of Thoracic Surgeons provides expert guidance for Cardiac and Thoracic Surgery. Sections include Pearson’s General Thoracic, Esphageal, Adult Cardiac, and Pediatric and Congenital Cardiac Surgery. Explore these free sample topics:

-- The first section of this topic is shown below --

Key Points

  • Surgery for tumors of the hypopharynx and cervical esophagus is complicated not only by the difficult resection but also by the reconstruction.
  • Numerous options are available to the surgeon for the reconstruction after pharyngolaryngectomy, including pedicled and free enteric grafts as well as pedicled and free myo/fasciocutaneous flaps.
  • Each of the approaches is associated with differing rates of success, complications and functional outcomes.
  • The optimal method of reconstruction is individualized to the patient and depends on the distal extent of the tumor, availability of donor sites, and surgeon preference.

Locally advanced squamous cell carcinoma of the hypopharynx and cervical esophagus represent the most common indications for pharyngolaryngectomy. These cancers are commonly diagnosed in advanced stages of disease, and the presentation of synchronous and metachronous lesions is not infrequent [1]. Patients frequently present with medical comorbidities, history of tobacco and alcohol abuse and poor nutritional condition, making this technically difficult surgery even more challenging [2]. Moreover, chemoradiation therapy has been installed as the standard initial therapy for most hypopharyngeal and cervical esophageal carcinomas, showing locoregional control and survival rates comparable to surgery followed by adjuvant radiation therapy, with better functional outcomes [3],[4]. Thus, these procedures are often performed in recurrent or persistent disease in previously irradiated patients, associated with a higher risk of complications compared with patients undergoing upfront surgery [5],[6]. The restoration of intestinal continuity also can present an imposing challenge. The goal for reconstruction is to balance the surgical morbidity of the procedure with the functional result considering swallowing and voice. Thus, the ideal mode of reconstruction would provide the lowest surgical morbidity, lowest stricture and fistula rate, and most rapid restoration of deglutition and speech. The options for reconstruction after pharyngolaryngectomy are numerous; the most common are presented in this chapter under the following headings: pedicled enteric conduits (stomach and colon); enteric free grafts (jejunal, gastro-omental); pedicled myocutaneous flaps (pectoralis major); and myocutaneous free grafts (radial forearm and anterolateral thigh). The optimal method of reconstruction is dependent on many factors, including the extent of disease, unavailability of various conduits due to previous treatment, and surgeon experience and preference. We review the technical aspects and discuss the benefits and disadvantages of each of these methods.

-- To view the remaining sections of this topic, please or --

Key Points

  • Surgery for tumors of the hypopharynx and cervical esophagus is complicated not only by the difficult resection but also by the reconstruction.
  • Numerous options are available to the surgeon for the reconstruction after pharyngolaryngectomy, including pedicled and free enteric grafts as well as pedicled and free myo/fasciocutaneous flaps.
  • Each of the approaches is associated with differing rates of success, complications and functional outcomes.
  • The optimal method of reconstruction is individualized to the patient and depends on the distal extent of the tumor, availability of donor sites, and surgeon preference.

Locally advanced squamous cell carcinoma of the hypopharynx and cervical esophagus represent the most common indications for pharyngolaryngectomy. These cancers are commonly diagnosed in advanced stages of disease, and the presentation of synchronous and metachronous lesions is not infrequent [1]. Patients frequently present with medical comorbidities, history of tobacco and alcohol abuse and poor nutritional condition, making this technically difficult surgery even more challenging [2]. Moreover, chemoradiation therapy has been installed as the standard initial therapy for most hypopharyngeal and cervical esophageal carcinomas, showing locoregional control and survival rates comparable to surgery followed by adjuvant radiation therapy, with better functional outcomes [3],[4]. Thus, these procedures are often performed in recurrent or persistent disease in previously irradiated patients, associated with a higher risk of complications compared with patients undergoing upfront surgery [5],[6]. The restoration of intestinal continuity also can present an imposing challenge. The goal for reconstruction is to balance the surgical morbidity of the procedure with the functional result considering swallowing and voice. Thus, the ideal mode of reconstruction would provide the lowest surgical morbidity, lowest stricture and fistula rate, and most rapid restoration of deglutition and speech. The options for reconstruction after pharyngolaryngectomy are numerous; the most common are presented in this chapter under the following headings: pedicled enteric conduits (stomach and colon); enteric free grafts (jejunal, gastro-omental); pedicled myocutaneous flaps (pectoralis major); and myocutaneous free grafts (radial forearm and anterolateral thigh). The optimal method of reconstruction is dependent on many factors, including the extent of disease, unavailability of various conduits due to previous treatment, and surgeon experience and preference. We review the technical aspects and discuss the benefits and disadvantages of each of these methods.

There's more to see -- the rest of this entry is available only to subscribers.

Last updated: April 6, 2020