Functional outcomes after circumferential pharyngoesophageal reconstruction.
OBJECTIVE
To determine functional speech and swallowing outcomes, morbidity, and complication rates after reconstruction of circumferential pharyngoesophageal defects using a jejunal versus an anterolateral thigh (ALT) flap.


METHODS
Retrospective analysis.


METHODS
We reviewed the medical records of 58 patients with circumferential pharyngoesophageal defects, 27 with ALT flap reconstruction, and 31 with jejunal interposition. We compared complication rates, intensive care unit (ICU) and hospital stays, nutritional intake, number of tracheoesophageal punctures (TEPs) performed, TE speech fluency, and functional use. Modified barium swallow studies assessed swallowing physiology.


RESULTS
Patient characteristics were similar. Total flap loss occurred in one (3.7%) patient with an ALT flap and two (6.5%) patients with jejunal interposition (P = 1.000), fistula in two (7.4%) ALT patients and one (3.2%) jejunal patient (P = .5931), and anastomotic stricture in four (15%) ALT patients and six (19.4%) jejunal patients (P = .7371). ICU and hospital stays were greater for jejunal patients (P = .001, <.001, respectively). TEPs were performed in eight jejunal patients and nine ALT patients. Eighty-nine percent of ALT patients and 63% of jejunal patients were fluent, whereas 78% of ALT patients and 25% of jejunal patients used TE speech to communicate. Ninety-one percent of ALT patients and 73% of jejunal patients resumed oral intake (P = .151). The most common causes of dysphagia were impaired tongue base retraction (62% jejunum) and disordered motility (62% jejunum, 67% ALT).


CONCLUSIONS
For circumferential pharyngoesophageal reconstruction, the ALT flap results in similar complication rates, but shorter ICU and hospital stays, and better speech and swallowing compared with jejunal reconstruction.
Department of Head and Neck Surgery, Section of Speech Pathology and Audiology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas 77030, USA. jlewin@mdanderson.org
Jan S
JS
Lewin
Denise A
DA
Barringer
Annette H
AH
May
Ann M
AM
Gillenwater
Katherine A
KA
Arnold
Dianna B
DB
Roberts
Peirong
P
Yu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology; D004938:Esophageal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D007583:Jejunum / Q000637:transplantation; D007822:Laryngeal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D010611:Pharyngectomy; D019651:Plastic Surgery Procedures; D012720:Severity of Illness Index; D013064:Speech Disorders / Q000175:diagnosis / Q000209:etiology*; D013524:Surgical Flaps; D013848:Thigh; D014059:Tongue / Q000503:physiopathology