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. 2015 Nov;272(11):3557-64.
doi: 10.1007/s00405-014-3358-y. Epub 2014 Dec 9.

Combined use of gastric pull-up and pectoralis major flaps for massive defects after total laryngopharyngoesophagectomy in patients with advanced hypopharyngeal carcinoma

Caiyun Zhang  1 , Shicai Chen  1 , Minhui Zhu  1 , Donghui Chen  1 , Hezhong Chen  2 , Hongliang Zheng  3
Affiliations

Combined use of gastric pull-up and pectoralis major flaps for massive defects after total laryngopharyngoesophagectomy in patients with advanced hypopharyngeal carcinoma

Caiyun Zhang et al. Eur Arch Otorhinolaryngol. 2015 Nov.

Abstract

Reconstruction for patients with advanced squamous cell carcinoma of the hypopharynx (SCCHP) after radical surgery is a challenge for head and neck surgeons, especially when one flap alone cannot entirely cover the defects. In this report, we describe the successful use of gastric pull-up combined with pectoralis major flaps for single-stage reconstruction after total laryngopharyngoesophagectomy in patients with SCCHP. We retrospectively reviewed the records of 23 patients with stage IV SCCHP who underwent this reconstructive procedure. Surgical details and perioperative morbidity were described, and functional and oncologic outcomes were evaluated. We used the gastric pull-up and pectoralis major flap procedure to reconstruct the defects for all 23 patients. In 13 patients the combined flaps were used to restore intestinal continuity, and in 10 patients the defects were repaired using gastric pull-up alone and covered by the pectoralis major flap. All the combined flaps worked well, and patients recovered normal swallowing function a mean 19.6 days after surgery. After an overall mean follow-up time of 25.3 months, six patients were still alive at the time of this analysis with no evidence of disease. Our results indicate that for patients with advanced SCCHP after total laryngopharyngoesophagectomy, using a pectoralis major flap combined with gastric pull-up enables one-stage reconstruction even when gastric pull-up alone cannot restore intestinal continuity. Furthermore, the functional and oncologic outcomes from this study suggest that this reconstructive procedure is safe and reliable, and more patients with advanced disease could be considered.

Keywords: Gastric pull-up; Hypopharyngeal cancer; Pectoralis major flap; Radical surgery.

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Figures

Fig. 1
Fig. 1
Preoperative MRI examination in a patient with a right piriform sinus lesion involving the cervical esophagus and oropharynx
Fig. 2
Fig. 2
Restoration of intestinal continuity using gastric pull-up and pectoralis major flaps. The stomach has been pulled up into the neck, and a pectoralis major flap has been raised and anastomosed to the posterior pharyngeal wall
Fig. 3
Fig. 3
Restoration of intestinal continuity using gastric pull-up and pectoralis major flaps. An inferiorly based flap is created from the surface of the stomach. The distal end of the flap is then sutured to the tongue base and the proximal end to the skin of the pectoralis major flap
Fig. 4
Fig. 4
Results of postoperative MRI examination in the same patient following a total laryngopharyngoesophagectomy to remove a left piriform sinus lesion involving the cervical esophagus and reconstruction with gastric pull-up and pectoralis major flaps
Fig. 5
Fig. 5
Postoperative endoscopy shows the normal condition of the gastric pull-up and pectoralis major flaps
See this image and copyright information in PMC

References

    1. Berrino F, Gatta G. Variation in survival of patients with head and neck cancer in Europe by the site of origin of the tumours. EUROCARE Working Group. Eur J Cancer. 1998;34(14 Spec No):2154–2161. doi: 10.1016/S0959-8049(98)00328-1. - DOI - PubMed
    1. Hall SF, Groome PA, Irish J, et al. The natural history of patients with squamous cell carcinoma of the hypopharynx. Laryngoscope. 2008;118:1362–1371. doi: 10.1097/MLG.0b013e318173dc4a. - DOI - PubMed
    1. Beauvillain C, Mahé M, Bourdin S, et al. Final results of a randomized trial comparing chemotherapy plus radiotherapy with chemotherapy plus surgery plus radiotherapy in locally advanced resectable hypopharyngeal carcinomas. Laryngoscope. 1997;107:648–653. doi: 10.1097/00005537-199705000-00017. - DOI - PubMed
    1. Lefebvre JL, Chevalier D, Luboinski B, et al. Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. J Natl Cancer Inst. 1996;88:890–899. doi: 10.1093/jnci/88.13.890. - DOI - PubMed
    1. Weber RS, Berkey BA, Forastiere A, et al. Outcome of radical total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91–11. Arch Otolaryngol Head Neck Surg. 2003;129:44–49. doi: 10.1001/archotol.129.1.44. - DOI - PubMed

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