title: Oncological outcome after free jejunal flap reconstruction for carcinoma of the hypopharynx.
abstract: It has been a common practice among the oncologist to reduce the dosage of adjuvant radiotherapy for patients after free jejunal flap reconstruction. The current aims to study potential risk of radiation to the visceral flap and the subsequent oncological outcome. Between 1996 and 2010, consecutive patients with carcinoma of the hypopharynx requiring laryngectomy, circumferential pharyngectomy and post-operative irradiation were recruited. Ninety-six patients were recruited. TNM tumor staging at presentation was: stage II (40.6%), stage III (34.4%) and stage IV (25.0%). Median follow-up period after surgery was 68 months. After tumor ablation, reconstruction was performed using free jejunal flap (60.4%), pectoralis major myocutaneous (PM) flap (31.3%) and free anterolateral thigh (ALT) flap (8.3%). All patients underwent adjuvant radiotherapy within 6.4 weeks after surgery. The mean total dose of radiation given to those receiving cutaneous and jejunal flap reconstruction was 62.2 Gy and 54.8 Gy, respectively. There was no secondary ischaemia or necrosis of the flaps after radiotherapy. The 5-year actuarial loco-regional tumor control for the cutaneous flap and jejunal flap group was: stage II (61 vs. 69%, p = 0.9), stage III (36 vs. 46%, p = 0.2) and stage IV (32 vs. 14%, p = 0.04), respectively. Reduction of radiation dosage in free jejunal group adversely affects the oncological control in stage IV hypopharyngeal carcinoma. In such circumstances, tubed cutaneous flaps are the preferred reconstructive option, so that full-dose radiotherapy can be given.
authors.affiliation: Division of Head and Neck Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong Li Ka Shing Faculty of Medicine, 102 Pokfulam Road, Hong Kong SAR, China. chanjyw@gmail.com
authors.forename: Jimmy Yu Wai
authors.initials: JY
authors.lastname: Chan
authors.forename: Velda Ling Yu
authors.initials: VL
authors.lastname: Chow
authors.forename: Richie Chiu Lung
authors.initials: RC
authors.lastname: Chan
authors.forename: Gregory Ian Siu Kee
authors.initials: GI
authors.lastname: Lau
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery; D004307:Dose-Response Relationship, Radiation; D005260:Female; D058752:Free Tissue Flaps / Q000009:adverse effects / Q000592:standards; D006085:Graft Survival / Q000528:radiation effects; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery; D007013:Hypopharynx / Q000473:pathology / Q000601:surgery; D007583:Jejunum / Q000637:transplantation*; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000009:adverse effects*; D016019:Survival Analysis
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