[Reconstruction after total circular pharyngolaryngectomy: comparison between gastric interposition and free jejunal flap].
OBJECTIVE
To elucidate hospital mortality, morbidity and actuarial survival rates of patients with carcinoma of the hypopharynx and cervical oesophagus and to identify the technique of choice for reconstruction after pharyngolaryngectomy.


METHODS
We reviewed the records of 209 patients who underwent total pharyngolaryngectomy between May 1982 and January 2000. The majority of patients had advanced cancer: hypopharyngeal in 131 cases and cervical oesophageal in 78 cases. Follow-up was complete for all patients. Chi 2 and log rank tests were used, with a limit of significance of 5%.


RESULTS
The postoperative mortality and morbidity rates were 4.8% and 38.3%, respectively. 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 with regard to the respiratory complications (33% vs 47.0%, p < 0.05), local recurrences (15.8% vs 33.8%, p = 0.004) and survival without dysphagia (76% vs 89%, p < 10(-5)).


CONCLUSIONS
Surgical ablation is a viable option for advanced hypopharyngeal and cervical oesophageal neoplasms, and stomach interposition is the preferred method of reconstruction.
Service de chirurgie digestive et générale, hôpital Claude-Huriez, CHRU place de Verdun, 59037 Lille, France.
C
C
Mariette
S
S
Fabre
J M
JM
Balon
P
P
Patenotre
D
D
Chevalier
J P
JP
Triboulet
D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D007583:Jejunum / Q000637:transplantation*; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality; D009367:Neoplasm Staging; D010611:Pharyngectomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013270:Stomach / Q000637:transplantation*; D013524:Surgical Flaps / Q000592:standards*; D016019:Survival Analysis; D016896:Treatment Outcome