Abstract
BackgroundAnterolateral thigh (ALT) free flap and jejunal flap (JF) were commonly used in tissue reconstruction for pharyngoesophageal squamous cell carcinoma (PESCC) with worsening tissue adhesion and necrosis after radiotherapy failure. However, the results of tissue reconstruction and postoperative complications of these two flaps are controversial. The purpose of this study was to compare outcomes between group ALT free flap and group JF in PESCC after radiotherapy failure.MethodsIntraoperative information and postoperative outcomes of patients with PESCC after radiotherapy failure who underwent ALT and JF reconstruction from January 2005 to December 2019 were compared and analyzed.ResultsThe defect size of ALT (Numbers, 34) and JF (Numbers, 31) was 36.19 ± 11.35 cm2 and 35.58 ± 14.32 cm2 (p = 0.884), respectively. ALT and JF showed no significant difference in operation time (p = 0.683) and blood loss (p = 0.198). For postoperative outcomes within 30 days both in recipient site and donor site including wound bleeding, wound dehiscence, wound infection, and pharyngocutaneous fistula, ALT free flap and JF showed similar results. Flap compromise (Numbers, 2 VS.3, p = 0.663), flap take backs (Numbers, 1 VS.1, p = 1.000), partial flap failures (Numbers, 4 VS.2, p = 0.674), and total flap failures (Numbers, 0 VS.0, p = 1.000) showed no difference between the two groups. In addition, no significance was found in hypoproteinemia between the two groups (Numbers, 4 VS.2, p = 0.674). ALT free flap was not statistically different from JF in the incidence of dysphagia at the postoperative 6 months (Numbers of liquid diet, 5VS.5; Numbers of partial tube feeding, 6VS.7; Numbers of total tube feeding, 3VS.1, p = 0.790) and 12 months (Numbers of liquid diet, 8VS.7; Numbers of partial tube feeding, 8VS.7; Numbers of total tube feeding, 5VS.5, p = 0.998). The cause of dysphagia not found to differ between the two groups both in postoperative 6 months (p = 0.814) and 12 months (p = 0.845).ConclusionCompared with JF, ALT free flap for PESCC patients after radiotherapy failure showed similar results in postoperative outcomes. ALT free flap may serve as a safe and feasible alternative for PESCC patients after radiotherapy failure.
Highlights
pharyngoesophageal squamous cell carcinoma (PESCC) is a malignant tumor of the head and neck with poor prognosis that invades the hypopharynx [1]
In total, 65 patients with PESCC at the age of 62.31 ± 12.57 and 59.48 ± 12.56 years who underwent Anterolateral thigh (ALT) flap surgery (n = 34; 25 males and 9 females) or jejunal flap (JF) surgery (n = 31; 23 males and 8 females) were enrolled in this study. 22 and 20 patients had a history of smoking, respectively. 20 and 22 had a history of alcohol abuse, respectively
The low, moderate and poor differentiation of the ALT and JF were 0 vs. 0, 28 vs. 26 and 6 vs. 5, respectively. 4 and 6 patients had a history of throat surgery in ALT and JF, respectively
Summary
PESCC is a malignant tumor of the head and neck with poor prognosis that invades the hypopharynx [1]. Large tissue defects caused by tumor resection are always a challenge for surgeons [2, 3]. The scar contracture caused by radiotherapy on the muscles, blood vessels and nerves within the head and neck tissue limits the use of the methods. ALT free flap has become increasingly prominent for the repair and reconstruction of head and neck tumors in recent years [9]. The present study aimed to analyze the outcomes of shortterm and long-term postoperative complications following ALT or JF reconstruction for patients with PESCC after radiotherapy failure. The purpose of this study was to compare outcomes between group ALT free flap and group JF in PESCC after radiotherapy failure
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