Reconstruction après pharyngolaryngectomie totale circulaire : comparaison de la plastie gastrique et du greffon de jejunum libre

Abstract

Aim of the study: To elucidate hospital mortality, morbidity and actuarial survival rates of patients with carcinoma of the hypopharynx and cervical œsophagus and to identify the technique of choice for reconstruction after pharyngolaryngectomy. Patients and methods: We reviewed the records of 209 patients who underwent total pharyngolaryngectomy between May 1982 and January 2000. The majority of patients had advanced cancer: hypopharyngeal in 131 cases and cervical œsophageal in 78 cases. Follow-up was complete for all patients. Chi 2 and log rank tests were used, with a limit of significance of 5%. Results: The postoperative mortality and morbidity rates were 4.8% and 38.3%, respectively. Alimentary continuity was achieved using the stomach (127 patients), colon (5 patients), or free jejunal autograft (77 patients). The 1-year and 5-year survival rates were 62% and 24%, respectively. There was no significant difference with regard to the survival between gastric transposition and free jejunal autograft, but there were fewer complications in the gastric pull-up group with regard to the respiratory complications (33% vs 47.0%, p < 0.05), local recurrences (15.8% vs 33.8%, p = 0.004) and survival without dysphagia (76% vs 89%, p < 10 –5). Conclusion: Surgical ablation is a viable option for advanced hypopharyngeal and cervical œsophageal neoplasms, and stomach interposition is the preferred method of reconstruction.