Reconstruction and Functional Evaluation of the Hypopharynx and Cervical Esophagus

Abstract

A total of 225 patients with carcinoma of the hypopharynx and the cervical esophagus were treated surgically between 1986 and 1996 at Osaka Medical Center for Cancer and Cardiovascular Diseases. There were the following three types of defect resulting from resection of carcinoma ; 119 partial (non-circumferential) pharyngeal, including nine with the preservation of the larynx, 91 circumferential pharyngeal and 15 pharyngoesophageal. Our principle of reconstruction was as follows ; Primary closure of the pharynx was indicated when the width of the pharyngeal remnant was more than 2 cm. For the partial pharyngeal defect with the width of less than 2 cm, the radial forearm free flap was utilized (patch reconstruction). And the free jejunal autogreft and gastric pull-up were utilized for the cicrcumferential type and the pharyngoesophageal type, respectively. There were 91 patients who had primary closures, 30 who had free forearm flaps, 57 who had free jejunal autografts, and 13 who had gastric pull-ups. Functions of these reconstructive techniques were evaluated by the interviews to the patients who had more than six-month follow-up. About 80% of the patients in each groups had no disturbance of diet passage ; 74% in primary closure (n=31), 80% in free forearm flap (n=5) and 77% in free jejunal autograft (n=13). More than 70% in each the three groups were able to take a fairely normal diet; 81%, 100% and 77%, respectively. The rates of use of neoesophageal speech in primary closure and free forearm were 58% and 80%, respectively, higher than that of 23% in free jejunal autograft. The only one case of severe dysphagia was reconstructed by free jejunal autograft, which was anastomosed to pharyngeal stump in end-to-side manner. There were two cases of pocket formation in the lower part of patch-on forearm flap, complaining of stagnant feeling of diet; which might result from too wide flap-width. An analysis using videofluorography revealed that neoglottis were located at the remnant mucosa near the lower or the upper anastomosis of free forearm flap and free jujunal autografts. These results suggested that the reconstructive method should be selected with reference to the type of defect, because of no significant difference of functions among reconstructive methods, and the reliability of materials, the simplicity of harvesting and the donor-site morbidity should be considered.