Salvage Surgery for Recurrent Carcinoma of the Hypopharynx and Reconstruction Using Jejunal Free Tissue Transfer and Pectoralis Major Muscle Pedicled Flap

Abstract

To evaluate patients undergoing salvage surgery after recurrent squamous cell carcinoma of the hypopharynx. Retrospective analysis. All patients underwent surgery and follow-up evaluations at the Medical University of Vienna. The departments of Surgery and Otorhinolaryngology carried out patient care and analysis of data. A total of 8 consecutive patients with recurrent hypopharyngeal squamous cell carcinoma. An interdisciplinary team of surgeons, including a head and neck surgeon, a reconstructive surgeon, and an abdominal surgeon, performed salvage surgery. After pharyngolaryngectomy and neck dissection, reconstruction using free, autotransplanted jejunum covered by a pectoralis major muscle flap was achieved. All data concerning the surgical procedure, perioperative morbidity, and functional and oncologic outcome were reviewed. The cohort of patients was heavily pretreated owing to late stages of disease at diagnosis. Mean time to recurrence before salvage surgery was 7.5 months. Mean time after surgery until ability to swallow was regained was 17.2 days, including 1 patient who ultimately underwent interventional dilation owing to stenosis. There were no complications requiring further surgical therapy, and all patients were transferred to outpatient care within 2 months. Three patients, all with advanced nodal involvement, died within months after surgery. Five patients are alive, 4 of whom have shown no evidence of disease 4 years or more after salvage surgery. Jejunal transfer and pectoralis major muscle flap were carried out in a single, reconstructive procedure after salvage resection in hypopharyngeal carcinoma. Potential long-term survival and minor perioperative and postoperative morbidity can be achieved using an interdisciplinary approach.