Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-22T03:05:45.422Z Has data issue: false hasContentIssue false
  • English
  • Français

Reconstructive techniques currently used following resection of hypopharyngeal carcinoma

Published online by Cambridge University Press:  29 June 2007

C. A. Ayshford ,
R. M. Walsh  and
J. C. Watkinson
C. A. Ayshford*
Affiliation:
Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham, UK.
R. M. Walsh
Affiliation:
Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham, UK.
J. C. Watkinson
Affiliation:
Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham, UK.
*
Address for correspondence: C. A. Ayshford, Dept of Otolaryngology, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TN. Fax: 0121 627 2299
Get access Rights & Permissions [Opens in a new window]

Abstract

There is no general consensus as to the best method of reconstruction following total laryngopharyngectomy for hypopharyngeal carcinoma. The aim of this study is to attempt to establish the current practice amongst British ENT Consultants and to ascertain the reasons for their choice of reconstructive technique.

An anonymous questionnaire was sent to 546 consultants in the UK and the results of 363 (66.5 per cent) were analysed. One hundred and twenty-eight (35.3 per cent) consultants replied that they performed surgery for hypopharyngeal carcinoma. Sixty-five (50.8 per cent) performed a stomach pull-up procedure, 23 (18 per cent) used a jejunal free flap, 36 (28.1 per cent) used both and four (3.1 per cent) used other techniques. In the stomach pull-up group, the main reasons given for their choice were because there was no lower resection margin (48 out of 65) and because of tradition in the way they were trained (37 out of 65). In the group using the jejunal free flap, lower morbidity (18 out of 23) and mortality (14 out of 23) were the main reasons for their choice. The questionnaire also found that amongst the 60 consultants who would consider using a jejunal free flap, the majority (39) aimed for a lower clearance margin of 2–4 cm, while 17 aimed for >4 cm clearance.

This study provides a good indication of the current practice in the UK of reconstruction following resection for hypopharyngeal carcinoma. It appears that the stomach pull-up remains the most commonly used method of reconstruction, but the jejunal free flap is becoming increasingly more popular because of its lower morbidity and mortality.

Keywords

Hypopharyngeal neoplasmsPharyngectomySurgical flaps
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 113 , Issue 2 , February 1999 , pp. 145 - 148
Copyright
Copyright © JLO (1984) Limited 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bradley, P. J. (1989) Survey of current management of laryngeal and hypopharyngeal cancer. Journal of the Royal College of Surgeons of Edinburgh 34: 197–200.Google ScholarPubMed
Czerny, F. (1877) Neue operationen. Zentralblatt fur Chirugie 4: 433–434.Google Scholar
Fisher, S. R., Cameron, R., Hoyt, D. J., Cole, T. B., Seigler, H. F., Meyers, W. C. (1990) Free jejunal interposition graft for reconstruction of the esophagus. Head and Neck Surgery 12: 126–130.Google Scholar
Gluckman, J. L., Crissman, J. D., Donegan, J. O. (1980) Multicentric squamous cell carcinoma of the upper aerodigestive tract. Head and Neck Surgery 3: 90–96.Google Scholar
Gluckman, J. L., Weissler, M. C., McCafferty, G., Black, R. J., Coman, W. W., Cooney, T., Bird, R. J. (1987) Partial vs total esophagectomy for advanced carcinoma of the hypopharynx. Archives of Otolaryngology – Head and Neck Surgery 113: 69–72.CrossRefGoogle ScholarPubMed
Goligher, J. C., Robin, I. G. (1954) Use of left colon for reconstruction of pharynx and esophagus after pharyngectomy. British Journal of Surgery 42: 283–290.Google Scholar
Harrison, D. F. N. (1970) Pathology of hypopharyngeal cancer in relation to surgical management. Journal of Laryngology and Otology 84: 349–367.CrossRefGoogle ScholarPubMed
Harrison, D. F. N., Thompson, A. E. (1986) Pharyngolaryngoesophagectomy with pharyngogastric anastomosis for cancer of the hypopharynx: review of 101 operations. Head and Neck Surgery 8: 418–428.Google Scholar
Ho, C. M., Lam, K. H., Wei, W. I., Yuen, P. O., Lam, L. K. (1993) Squamous cell carcinoma of the hypopharynx – analysis of treatment results. Head and Neck Surgery 15: 405–412.Google Scholar
Ho, C. M., Ng, W. F., Lam, H. L., Wei, W. I., Yuen, A. P. W. (1997) Submucosal tumor extension in hypopharyngeal cancer. Archives of Otolaryngology – Head and Neck Surgery 123: 959–965.Google Scholar
Huguier, M., Gardin, F., Maillard, J. N., Lortat-Jacob, J. L. (1970) Results of 117 esophageal replacements. Surgery Gynecology and Obstetrics 130: 1054–1058.Google ScholarPubMed
Jones, A. S., Roland, N. J., Husband, D., Hamilton, J. W., Gati, I. (1996) Free revascularized jejunal loop repair following total pharyngolaryngectomy for carcinoma of the hypopharynx: report of 90 patients. British Journal of Surgery 83: 1279–1283.Google Scholar
Ong, G. B., Lee, T. C. (1960) Pharyngogastric anastomosis after esophagopharyngectomy for carcinoma of the hypopharynx and cervical esophagus. British Journal of Surgery 48: 193–200.Google Scholar
Sasaki, C. T., Salzer, S. J., Cahow, E., Son, Y., Ward, B. (1995) Laryngoesophagectomy for advanced hypopharyngeal and esophageal squamous cell carcinoma: the Yale experience. Laryngoscope 105: 160–163.Google Scholar
Spiro, R. H., Bains, S., Shah, J. P., Strong, E. W. (1991) Gastric transposition for head and neck cancer: a critical update. American Journal of Surgery 162: 348–352.Google Scholar
Surkin, M. I., Lawson, W., Biller, H. F. (1984) Analysis of methods of pharyngoesophageal reconstruction. Head and Neck Surgery 6: 953–970.Google Scholar
Theogaraj, S. D., Merrit, W. H., Acharya, G., Cohen, I. K. (1980) The pectoralis major myocutaneous island flap in single-stage reconstruction of the pharyngoesophageal region. Plastic Reconstructive Surgery 65: 267–276.CrossRefGoogle Scholar
Wookey, H. (1942) The surgical treatment of carcinoma of the pharynx and upper oesophagus. Surgery Gynecology and Obstetrics 75: 449–506.Google Scholar