Download PDF
J Reconstr Microsurg 2014; 30(09): 641-654
DOI: 10.1055/s-0034-1376887
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pharyngoesophageal Reconstruction Outcomes Following 349 Cases

Jesse C. Selber
1   Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas
,
Amy Xue
2   Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
,
Jun Liu
1   Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas
,
Matthew M. Hanasono
1   Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas
,
Roman J. Skoracki
1   Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas
,
Edward I. Chang
1   Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas
,
Peirong Yu
1   Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas
› Author Affiliations
Further Information

Publication History

18 January 2014

06 March 2014

Publication Date:
04 July 2014 (online)

Also available at
    Permissions and Reprints

Abstract

Background Pharyngoesophageal (PE) reconstruction is complex, with a diverse set of reconstructive considerations. This large series examines the impact of various defect characteristics and reconstructive modalities on outcomes.

Patients and Methods A retrospective review identified 349 cases from 2000 to 2011. Patients were grouped according to defect extent and location. Groups were compared by comorbidities, flap type, donor and recipient site complications, postoperative diet, and tracheoesophageal speech.

Results Of 349 cases, 193 (55.3%) PE defects were circumferential and 156 (44.7%) were partial. The majority of defects resulted from laryngopharyngectomy (72.5%), most reconstructed with the anterolateral thigh flap (60%). There were 15.5% total esophagectomies, all of which received supercharged jejunal flaps. Of 349 patients, 81 patients (23.2%) had recipient site complications and 51 patients (14.6%) had donor site complications. The fistula rate trended higher in circumferential defects (11 vs. 6%, p = 0.144), and the stricture rate was significantly higher (9.3 vs. 3.8%, p = 0.044). In total, 302 patients (86.5%) had an oral diet after reconstruction, 64 (18%) of whom required supplemental tube feeds. Among 147 patients (42%) who received tracheoesophageal puncture (TEP), 19 (12.9%) eventually failed. Approximately 87% of patients with TEPs achieved fluent speech. The 5-year survival was low for all groups, ranging from 0 to 35%.

Conclusions PE reconstruction can be performed safely, and most patients will achieve functional speech and swallowing. Swallowing function is worse when the larynx is removed, and the stricture rate is higher with circumferential defects. Specific technical measures can reduce the rate of common complications.

Level of Evidence The level of evidence of this article was level III.

Keywords

pharyngoesophageal reconstruction - head and neck reconstruction - anterolateral thigh flap - supercharged jejunem

Note

This work was presented at the American Association of Plastic Surgeons in New Orleans, LA in April 2013.


 

  • References

  • 1 Carlson GW, Schusterman MA, Guillamondegui OM. Total reconstruction of the hypopharynx and cervical esophagus: a 20-year experience. Ann Plast Surg 1992; 29 (5) 408-412
    CrossrefPubMedGoogle Scholar
  • 2 Iteld L, Yu P. Pharyngocutaneous fistula repair after radiotherapy and salvage total laryngectomy. J Reconstr Microsurg 2007; 23 (6) 339-345
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Yu P. One-stage reconstruction of complex pharyngoesophageal, tracheal, and anterior neck defects. Plast Reconstr Surg 2005; 116 (4) 949-956
    CrossrefPubMedGoogle Scholar
  • 4 Yu P, Hanasono MM, Skoracki RJ , et al. Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy. Cancer 2010; 116 (7) 1718-1724
    CrossrefPubMedGoogle Scholar
  • 5 Yu P, Lewin JS, Reece GP, Robb GL. 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 2006; 117 (3) 968-974
    CrossrefPubMedGoogle Scholar
  • 6 Yu P, Robb GL. Pharyngoesophageal reconstruction with the anterolateral thigh flap: a clinical and functional outcomes study. Plast Reconstr Surg 2005; 116 (7) 1845-1855
    CrossrefPubMedGoogle Scholar
  • 7 Disa JJ, Pusic AL, Hidalgo DA, Cordeiro PG. Microvascular reconstruction of the hypopharynx: defect classification, treatment algorithm, and functional outcome based on 165 consecutive cases. Plast Reconstr Surg 2003; 111 (2) 652-660 , discussion 661–663
    CrossrefPubMedGoogle Scholar
  • 8 Maclean J, Szczesniak M, Cotton S, Cook I, Perry A. Impact of a laryngectomy and surgical closure technique on swallow biomechanics and dysphagia severity. Otolaryngol Head Neck Surg 2011; 144 (1) 21-28
    CrossrefPubMedGoogle Scholar
  • 9 Moradi P, Glass GE, Atherton DD , et al. Reconstruction of pharyngolaryngectomy defects using the jejunal free flap: a 10-year experience from a single reconstructive center. Plast Reconstr Surg 2010; 126 (6) 1960-1966
    CrossrefPubMedGoogle Scholar
  • 10 Anthony JP, Singer MI, Mathes SJ. Pharyngoesophageal reconstruction using the tubed free radial forearm flap. Clin Plast Surg 1994; 21 (1) 137-147
    PubMedGoogle Scholar
  • 11 Burkey BB. Pharyngoesophageal reconstruction. Curr Opin Otolaryngol Head Neck Surg 1995; 3: 267-271
    CrossrefPubMedGoogle Scholar
  • 12 Magdy EA. Pharyngoesophageal reconstruction. Curr Opin Otolaryngol Head Neck Surg 2001; 9: 225-230
    CrossrefPubMedGoogle Scholar
  • 13 Burke MS, Kaplan SE, Kaplowitz LJ , et al. Pectoralis major myocutaneous flap for reconstruction of circumferential pharyngeal defects. Ann Plast Surg 2013; 71 (6) 649-651
    CrossrefPubMedGoogle Scholar
  • 14 Chan YW, Ng RW, Liu LH, Chung HP, Wei WI. Reconstruction of circumferential pharyngeal defects after tumour resection: reference or preference. J Plast Reconstr Aesthet Surg 2011; 64 (8) 1022-1028
    CrossrefPubMedGoogle Scholar
  • 15 Chu PY, Chang SY. Reconstruction of circumferential pharyngoesophageal defects with laryngotracheal flap and pectoralis major myocutaneous flap. Head Neck 2002; 24 (10) 933-939
    CrossrefPubMedGoogle Scholar
  • 16 Andrews BT, McCulloch TM, Funk GF, Graham SM, Hoffman HT. Deltopectoral flap revisited in the microvascular era: a single-institution 10-year experience. Ann Otol Rhinol Laryngol 2006; 115 (1) 35-40
    CrossrefPubMedGoogle Scholar
  • 17 Chaffoo RAK, Goode RL. Modification of the deltopectoral flap for pharyngoesophageal reconstruction. Laryngoscope 1988; 98 (4) 460-462
    PubMedGoogle Scholar
  • 18 Lodish EM. The use of the deltopectoral flap in reconstruction for pharyngoesophageal carcinoma. J Am Osteopath Assoc 1977; 76 (11) 89-96
    PubMedGoogle Scholar
  • 19 McCarthy CM, Kraus DH, Cordeiro PG. Tracheostomal and cervical esophageal reconstruction with combined deltopectoral flap and microvascular free jejunal transfer after central neck exenteration. Plast Reconstr Surg 2005; 115 (5) 1304-1310 , discussion 1311–1313
    CrossrefPubMedGoogle Scholar
  • 20 Chen HC, Rampazzo A, Gharb BB , et al. Motility differences in free colon and free jejunum flaps for reconstruction of the cervical esophagus. Plast Reconstr Surg 2008; 122 (5) 1410-1416
    CrossrefPubMedGoogle Scholar
  • 21 Chernousov AF, Andrijanov VA, Bogopolsky PM, Voronov ME, Titov VV. Colonic esophagopharyngoplasty in combined chemical esophageal and pharyngeal strictures. Int Surg 1999; 84 (1) 1-6
    PubMedGoogle Scholar
  • 22 Lin TS, Fang HY, Chang CC , et al. Free transverse colon transfer for pharyngoesophageal reconstruction in treating hypopharyngeal Carcinoma: A case report. Formosan J Surgery 2000; 33: 26-29
    PubMedGoogle Scholar
  • 23 Lu HI, Kuo YR, Chien CY. Extended left colon interposition for pharyngoesophageal reconstruction using distal-end arterial enhancement. Microsurgery 2008; 28 (6) 424-428
    CrossrefPubMedGoogle Scholar
  • 24 Matros E, Cordeiro PG. Single-stage reconstruction of composite central neck defects with the double-island vertical rectus abdominis musculocutaneous flap. Ann Plast Surg 2011; 66 (2) 164-167
    CrossrefPubMedGoogle Scholar
  • 25 Weber RS, Marvel J, Smith P, Hankins P, Wolf P, Goepfert H. Paratracheal lymph node dissection for carcinoma of the larynx, hypopharynx, and cervical esophagus. Otolaryngol Head Neck Surg 1993; 108 (1) 11-17
    PubMedGoogle Scholar
  • 26 Marsh DJ, Chana JS. Reconstruction of very large defects: a novel application of the double skin paddle anterolateral thigh flap design provides for primary donor-site closure. J Plast Reconstr Aesthet Surg 2010; 63 (1) 120-125
    CrossrefPubMedGoogle Scholar
  • 27 Tan NC, Yeh MC, Shih HS, Nebres RP, Yang JC, Kuo YR. Single free anterolateral thigh flap for simultaneous reconstruction of composite hypopharyngeal and external neck skin defect after head and neck cancer ablation. Microsurgery 2011; 31 (7) 524-528
    CrossrefPubMedGoogle Scholar
  • 28 Koshima I, Moriguchi T, Soeda S, Yamamoto H, Orita Y, Hara A. Extended latissimus dorsi musculocutaneous flaps for extremely wide cervical skin defects involving the cervical esophagus. Ann Plast Surg 1992; 29 (2) 149-152
    CrossrefPubMedGoogle Scholar
  • 29 Ho MW, Houghton L, Gillmartin E , et al. Outcomes following pharyngolaryngectomy reconstruction with the anterolateral thigh (ALT) free flap. Br J Oral Maxillofac Surg 2012; 50 (1) 19-24
    CrossrefPubMedGoogle Scholar
  • 30 Maciejewski A, Krakowczyk Ł, Szymczyk C , et al. Salvage surgery of recurrence after laryngectomy—when should the alt free flap be modified?. Med Sci Monit 2012; 18 (4) CS31-CS36
    PubMedGoogle Scholar
  • 31 Akin S, Basut O. A new flap design for monitoring the circulation of a buried free radial forearm flap in pharyngoesophageal reconstruction. J Reconstr Microsurg 2002; 18 (7) 591-594
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Yang JCS, Kuo YR, Hsieh CH, Jeng SF. The use of radial vessel stump in free radial forearm flap as flap monitor in head and neck reconstruction. Ann Plast Surg 2007; 59 (4) 378-381
    CrossrefPubMedGoogle Scholar
  • 33 Wadsworth JT, Futran N, Eubanks TR. Laparoscopic harvest of the jejunal free flap for reconstruction of hypopharyngeal and cervical esophageal defects. Arch Otolaryngol Head Neck Surg 2002; 128 (12) 1384-1387
    CrossrefPubMedGoogle Scholar
  • 34 Kelly KE, Anthony JP, Singer M. Pharyngoesophageal reconstruction using the radial forearm fasciocutaneous free flap: preliminary results. Otolaryngol Head Neck Surg 1994; 111 (1) 16-24
    CrossrefPubMedGoogle Scholar
  • 35 Lee JC, Hsu WT, Yang CC, Chang SH. A fabricated forearm free flap with accompanying phonation tube for simultaneous reconstruction of a pharyngolaryngeal circumferential defect and voice loss: new surgical modification with functional phonation outcome. Laryngoscope 2013; 123 (2) 344-349
    CrossrefPubMedGoogle Scholar
  • 36 Chen HC, Tang YB, Noordhoff MS. Patch esophagoplasty with free forearm flap for focal stricture of the pharyngoesophageal junction and the cervical esophagus. Plast Reconstr Surg 1992; 90 (1) 45-52
    CrossrefPubMedGoogle Scholar
  • 37 Yamada K, Fukuda S, Yagi K , et al. Analysis of outcome of free jejunal-autograft for head and neck reconstruction—postoperative complications and functional results of swallowing in 49 cases [in Japanese]. Nippon Jibiinkoka Gakkai Kaiho 1999; 102 (12) 1279-1286
    CrossrefPubMedGoogle Scholar
  • 38 Annino Jr DJ, Goguen LA. Mitomycin C for the treatment of pharyngoesophageal stricture after total laryngopharyngectomy and microvascular free tissue reconstruction. Laryngoscope 2003; 113 (9) 1499-1502
    CrossrefPubMedGoogle Scholar
  • 39 Fujiwara T, Shih HS, Chen CC, Tay SKL, Jeng SF, Kuo YR. Interdigitation of the distal anastomosis between tubed fasciocutaneous flap and cervical esophagus for stricture prevention. Laryngoscope 2011; 121 (2) 289-293
    CrossrefPubMedGoogle Scholar
  • 40 Güler MM, Işik S, Sezgin M. Pharyngoesophageal reconstruction with the tubed radial forearm free flap. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology. Head Neck Surg 1998; 255: 24-26
    PubMedGoogle Scholar