Background Free jejunal transfer has become the standard technique for reconstruction of the pharynx and hypopharynx, especially with proximal neoplastic lesions, whereas gastric tube interposition is the technique of choice for reconstruction of the hypopharynx and cervical esophagus when resection extends below the thoracic inlet. Hypothesis Surgical ablation is a viable option for advanced hypopharyngeal and cervical esophageal neoplasms, with stomach interposition a safe and preferred method of reconstruction. Design Retrospective analysis. Setting University hospital that is a regional referral institution for esophageal cancer treatment and complex digestive reconstructions after esophagectomy. Patients We reviewed the records of 209 patients who underwent total pharyngolaryngectomy between May 1982 and July 1999. The majority of patients had advanced cancer: hypopharyngeal in 131 cases and cervical esophageal in 78 cases. Interventions Pharyngolaryngectomy and total esophagectomy with pharyngogastric anastomoses (n = 127); pharyngolaryngectomy, cervical esophagectomy, and reconstruction with free jejunal transplant (n = 77); and pharyngolaryngectomy and total esophagectomy with pharyngocolic anastomoses (n = 5). Main Outcome Measures Postoperative mortality and morbidity, long-term survival, and prognostic factors influencing survival. Results The postoperative in-hospital mortality rate was 4.8% (10 patients), with a postoperative morbidity rate of 38.3%. Alimentary continuity was achieved using the stomach (127 patients), colon (5 patients), or free jejunal autograft (77 patients). The 1-year and 5-year survival rates were 62% and 24%, respectively. There was no significant difference with regard to the survival between gastric transposition and free jejunal autograft, but there were fewer complications in the gastric pull-up group (33% vs 47%, P Conclusions Surgical ablation is a viable option for advanced hypopharyngeal and cervical esophageal neoplasms, with stomach interposition the preferred method of reconstruction. Although the prognosis is poor, satisfactory short-term palliation can be achieved. The significant adverse factors affecting survival should be taken into account to select the candidates for surgery.

https://jamanetwork.com/journals/jamasurgery/articlepdf/392217/soa1009.pdf

Surgical management of carcinoma of the hypopharynx and cervical esophagus: analysis of 209 cases.

Background:Pharyngoesophageal defects are commonly reconstructed with free jejunal or fasciocutaneous flaps, with various outcomes, and a direct comparison is lacking.Methods:Fifty-seven circumferential pharyngoesophageal reconstructions with an anterolateral thigh flap (n = 26 patients) performed b

Comparison of clinical and functional outcomes and hospital costs following pharyngoesophageal reconstruction with the anterolateral thigh free flap versus the jejunal flap.

Background:Functional outcomes and morbidities of pharyngoesophageal reconstruction have not been satisfactory. The purpose of the present study was to evaluate such outcomes following pharyngoesophageal reconstruction with the anterolateral thigh flap.Methods:Reconstruction of pharyngoesophageal de

Pharyngoesophageal reconstruction with the anterolateral thigh flap: a clinical and functional outcomes study.

During the 5-year period from July 1984 to 1988, 72 patients over the age of 50 underwent microvascular free tissue transfers for head and neck reconstruction. There were 22 patients aged 50-59 years, 31 patients aged 60-69 years, and 19 patients aged 70-79 years. Seventy of these procedures (97%) were done at the time of ablative surgery utilizing a two-team approach. There was 1 total flap loss for a flap viability rate of 99% (73/74). There were 46 complications in 40 patients: 21 surgical and 25 medical. Twelve of the surgical complications required reoperation for a major surgical complication rate of 16%. Major medical complications developed in 12 patients (16%). Medical complications more commonly were observed in patients aged 60-69 years who had significant preoperative comorbidity and were classified as ASA class 3 or greater. There were 5 postoperative deaths for a mortality rate of 7%. Advanced chronologic age does not compromise the technical success of microsurgical free tissue transfer in the elderly patient with head and neck cancer. The risk of medical complications is significant and is directly related to concurrent illness of the individual patient rather than to age alone.

Effect of advanced age and medical disease on the outcome of microvascular reconstruction for head and neck defects.

Pharyngoesophageal reconstruction using the tubed free radial forearm flap.

Use of enteric grafts is a popular method for reconstruction of the cervical esophagus and hypopharynx. Free jejunal transfer (FJT) and gastric pull-up (GP) are the most popular methods used. This discussion is a retrospective review of our experience with 50 cases of free jejunal transfer and 15 cases of gastric pull-up. The graft survival rate was 94 percent (47 of 50) for free jejunal transfer and 87 percent (13 of 15) for gastric pull-up. Successful swallowing was achieved in 88 percent (44 of 50) of free jejunal transfers and 87 percent (13 of 15) of gastric pull-ups. Patients with free jejunal transfers were able to swallow and leave the hospital sooner: 10.6 versus 16.0 days and 22.3 versus 29.0 days, respectively. Fistulas occurred in 16 percent (8 of 50) of free jejunal transfers, most of which (6 of 8) healed spontaneously. Fistulas occurred in 20 percent (3 of 15) of gastric pull-ups, only one of which healed spontaneously. Stricture was the most common late complication for free jejunal transfers, 22 percent (11 of 50), whereas reflux was most common in gastric pull-ups, 20 percent (3 of 15). In patients with advanced cancer, extensive esophageal resection into the chest is often required, and gastric pull-up seems to be an easier and more direct form of reconstruction. In limited resection of the hypopharynx and esophagus, especially with proximal lesions, free jejunal transfer is simpler and avoids mediastinal dissection. This concept as well as other advantages and disadvantages of both techniques will be discussed.

Reconstruction of the cervical esophagus: Free jejunal transfer versus gastric pull-up

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Reconstruction of the cervical esophagus: Free jejunal transfer versus gastric pull-up