title: Pharyngoesophageal reconstruction outcomes following 349 cases.
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.
  
  
  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.
  
  
  METHODS
  The level of evidence of this article was level III.
authors.affiliation: Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Selber
authors.affiliation: Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Amy
authors.initials: A
authors.lastname: Xue
authors.affiliation: Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hanasono
authors.affiliation: Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Roman J
authors.initials: RJ
authors.lastname: Skoracki
authors.affiliation: Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Edward I
authors.initials: EI
authors.lastname: Chang
authors.affiliation: Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Peirong
authors.initials: P
authors.lastname: Yu
mesh_terms: D000368:Aged; D000465:Algorithms; D003679:Deglutition; D016629:Esophagectomy; D004947:Esophagus / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects; D010614:Pharynx / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome