The use of revascularized ileocolic autografts for primary repair after pharyngolaryngoesophagectomy

Abstract

Total replacement of the cervical esophagus and hypopharynx after pharyngolaryngoesophagectomy for malignant neoplasms was accomplished successfully in two patients with the use of a revascularized isolated intestinal segment. The ileocolic artery was anastomosed to the external carotid artery and the ileocolic vein to the internal jugular vein. In one patient unilateral neck dissection and in the other patient bilateral simultaneous neck dissection was performed. The terminal ileum supplied by the ileocolic vessels appears to be the most suitable segment for transplantation because of the constancy and the size of the vessels. The terminal ileum is preferable to the colon since the small intestine more closely approximates the diameter of the cervical esophagus and pharynx and has a thicker wall and a better blood supply. The advantages of this procedure are many: 1. (1) It permits wide extirpation of the primary tumor with an adequate margin without fear of having inadequate tissue to close the defect. 2. (2) Resection of the tumor and restoration of deglutition are accomplished in a single stage. 3. (3) The frequent complications of fistula and stricture formation seen with skin-lined tubes can be avoided. 4. (4) The thoracic cavity is not entered as is necessary with gastric or colonic transpositions. 5. (5) It eliminates the problem of insufficient length of the substituted segment. 6. (6) The abdominal portion of the procedure can usually be accomplished quickly and with low risk, equivalent to right ileocolectomy. 7. (7) The ileocolic vessels are the most constant and largest of the mesenteric vessels suitable for transplant. 8. (8) The caliber of the terminal ileum, the thickness of the small bowel wall, and its richer blood supply make for a substitute intrinsically superior to the colon. 9. (9) Cervical lymph node metastases can be dealt with by unilateral or bilateral radical neck dissection. 10. (10) Prior radiation to the cervical skin is no contraindication. 11. (11) It eliminates the need for a pharyngostoma. We believe the operation deserves wider application and trial in suitable patients with malignancies of the pharynx, larynx, and cervical esophagus.