Evaluating the free radial forearm flap versus the pedicled pectoralis major myocutaneous flap for oesophago-pharyngeal reconstruction: decision making, outcome and literature review

Abstract

The successful reconstruction of oesophago-hypopharyngeal defects is a challenge and the choice of the best reconstructive option is still controversial. The purposes of this study were to evaluate the use of the free radial forearm flap (RFF) or the pedicled pectoralis major (PM) flap for oesophago-hypopharyngeal reconstruction and to review the literature, considering the free flap option as the state of the art. The decision making, outcome and common complications were assessed. From 2013 to 2018, 15 sequential patients with laryngeal carcinoma, 61 years and BMI 24.6, were included in this retrospective study. They underwent laryngectomy-pharyngo/esophagectomy and immediate or secondary pharyngoesophageal reconstruction. Nine patients underwent reconstruction with RFF (group A) and six with PM flap (group B). We excluded patients with history of thoracic and breast surgery and synchronous malignancy. We used the SPSS v.21 for statistical analysis. The duration of surgery for RFF was longer (731 min versus 435 min). Postoperatively, all patients received radiotherapy, whereas chemotherapy was administered in one patient. The RFF was the procedure of choice for stages III–IV and larger defects and the PM for stage II (p = 0.002). Overall complication rates, fistula, stricture and swallowing dysfunction were found higher in group B, but not significant (pCompl = 0.315, pFist = 1.000, pStrict/Swall = 0.143). Furthermore, the secondary PM reconstructions had non-statistically significant even higher fistula and swallowing dysfunction rates (p = 0.400). Both groups reported equal good results in terms of oral alimentation and speech. We found that the RFF and PM flap could provide comparable outcomes in oesophago-pharyngeal reconstruction. The RFF seems to be a superior reconstructive option for advanced disease and larger defects and is associated with better swallowing and fewer complications Level of evidence: Level III, therapeutic study.