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.
Highlights
Squamous cell carcinoma of the hypopharynx (SCCHP), a classification that includes tumors of the piriform sinus, postcricoid area, and posterior pharyngeal wall, is an aggressive cancer in the head and neck region [1]
We describe the successful use of gastric pull-up combined with pectoralis major flaps for single-stage reconstruction after total laryngopharyngoesophagectomy in patients with squamous cell carcinoma of the hypopharynx (SCCHP)
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
Summary
Squamous cell carcinoma of the hypopharynx (SCCHP), a classification that includes tumors of the piriform sinus, postcricoid area, and posterior pharyngeal wall, is an aggressive cancer in the head and neck region [1]. Most patients with advanced SCCHP have disease in regional lymph nodes at presentation. Treatment of patients with advanced SCCHP with chemoradiation is effective in preserving laryngeal function without compromising the survival rates obtained previously by primary surgery. Larynx-preserving therapies have been shown to preserve larynx function in about half of the patients at 3–5 years. In patients who failed chemoradiation or present with residual disease or develop recurrent disease, palliative treatments will result in moderately short overall survival durations with poor quality of life [3, 4]. Surgical treatment should be considered for patients with those advanced SCCHP to return them to a disease-free state [5–7]
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