title: Hypopharyngeal reconstruction: a comparison of three alternatives.
abstract: This study aimed to evaluate the operative outcomes of using gastric pull-up (GPU), pectoralis major myocutaneous flap (PMMF), and jejunal free flap (JFF) to reconstruct the hypopharynx after resection of hypopharyngeal and cervical esophageal carcinoma. Retrospective clinical study. Otolaryngology Department, Zagazig University Hospital, Egypt and Surgical Department, National Cancer Institute, Cairo, Egypt. Records of 104 patients who underwent resection of carcinoma of the hypopharynx and cervical esophagus were reviewed to determine the indications for radical resection, location, and stage of the primary tumor, gross and pathological surgical resection margins, operative complications, morbidity, and mortality. Reconstruction was performed using the GPU for group (1) (n = 33), PMMF for group (2) (n = 34), and JFF for group (3) (n = 37). The hypopharynx was the most common primary tumor site for group (2) and group (3) whereas group (1) had lesions more frequently in the cervical esophagus. The overall postoperative morbidity rate was 20.2% with a perioperative mortality rate of 6.7% and there was no significant difference between the three groups. There was no graft necrosis in group (1) compared to 5.9% in group (2) and 5.4% in group (3). Pulmonary complications occurred commonly (30.3%) in group (1) compared to 11.8% in group (2) and 10.8% in group (3) The overall 3 years survival rate was 67.3% and there was no significant difference between the three groups. The outcomes of the three techniques are equally successful when used appropriately. The nature of the defect indicates the method of reconstruction. For short reconstruction above the thoracic inlet, PMMF or JFF are equally effective and in tumors requiring total esophagectomy, GPA is indicated.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, 4419, Egypt, Alaaelfeky_zag@yahoo.com.
authors.forename: Alaa Eldin
authors.initials: AE
authors.lastname: Elfeky
authors.forename: Wail Fayez
authors.initials: WF
authors.lastname: Nasr
authors.forename: Alaa
authors.initials: A
authors.lastname: Khazbak
authors.forename: Mohamed Said
authors.initials: MS
authors.lastname: Abdelrahman
authors.forename: Zaki Abdelgawad
authors.initials: ZA
authors.lastname: Allam
authors.forename: Wahed Yousry
authors.initials: WY
authors.lastname: Gareer
authors.forename: Hesham
authors.initials: H
authors.lastname: Elsebaey
mesh_terms: D002277:Carcinoma / Q000473:pathology / Q000601:surgery; D004534:Egypt; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy / Q000379:methods / Q000534:rehabilitation; D004944:Esophagoplasty / Q000009:adverse effects / Q000379:methods; D005260:Female; D058752:Free Tissue Flaps / Q000009:adverse effects*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery; D007583:Jejunum / Q000637:transplantation*; D007825:Laryngectomy / Q000379:methods / Q000534:rehabilitation; D058753:Laryngoplasty / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000009:adverse effects*; D009333:Neck / Q000601:surgery; D009367:Neoplasm Staging; D010369:Pectoralis Muscles / Q000637:transplantation*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome