title: Combined use of gastric pull-up and pectoralis major flaps for massive defects after total laryngopharyngoesophagectomy in patients with advanced hypopharyngeal carcinoma.
abstract: Reconstruction for patients with advanced squamous cell carcinoma of the hypopharynx (SCCHP) after radical surgery is a challenge for head and neck surgeons, especially when one flap alone cannot entirely cover the defects. In this report, we describe the successful use of gastric pull-up combined with pectoralis major flaps for single-stage reconstruction after total laryngopharyngoesophagectomy in patients with SCCHP. We retrospectively reviewed the records of 23 patients with stage IV SCCHP who underwent this reconstructive procedure. Surgical details and perioperative morbidity were described, and functional and oncologic outcomes were evaluated. We used the gastric pull-up and pectoralis major flap procedure to reconstruct the defects for all 23 patients. In 13 patients the combined flaps were used to restore intestinal continuity, and in 10 patients the defects were repaired using gastric pull-up alone and covered by the pectoralis major flap. All the combined flaps worked well, and patients recovered normal swallowing function a mean 19.6 days after surgery. After an overall mean follow-up time of 25.3 months, six patients were still alive at the time of this analysis with no evidence of disease. Our results indicate that for patients with advanced SCCHP after total laryngopharyngoesophagectomy, using a pectoralis major flap combined with gastric pull-up enables one-stage reconstruction even when gastric pull-up alone cannot restore intestinal continuity. Furthermore, the functional and oncologic outcomes from this study suggest that this reconstructive procedure is safe and reliable, and more patients with advanced disease could be considered.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China.
authors.forename: Caiyun
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China.
authors.forename: Shicai
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China.
authors.forename: Minhui
authors.initials: M
authors.lastname: Zhu
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China.
authors.forename: Donghui
authors.initials: D
authors.lastname: Chen
authors.affiliation: Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China.
authors.forename: Hezhong
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China. zheng_hl2004@163.com.
authors.forename: Hongliang
authors.initials: H
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010611:Pharyngectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D013524:Surgical Flaps
keywords: Gastric pull-up; Hypopharyngeal cancer; Pectoralis major flap; Radical surgery