Modified pharyngogastrostomy by a stapler technique

The comparison of manual and mechanical anastomosis after total pharyngolaryngoesophagectomy

Background

Total pharyngolaryngoesophagectomy (TPLE) is considered as a curative treatment for hypopharynx cancer and cervical esophageal carcinomas (HPCECs). Traditional pharyngo-gastric anastomosis is usually performed manually, and postoperative complications are common. The aim of this study was to introduce a new technique for mechanical anastomosis and to evaluate perioperative outcomes and prognosis.

Methods

From May 1995 to Nov 2021, a series of 75 consecutive patients who received TPLE for a pathological diagnosis of HPCECs at Sun Yat-sen Memorial Hospital were evaluated. Mechanical anastomosis was performed in 28 cases and manual anastomosis was performed in 47 cases. The data from these patients were retrospectively analyzed.

Results

The mean age was 57.6 years, and 20% of the patients were female. The rate of anastomotic fistula and wound infection in the mechanical group were significantly lower than that in the manual group. The operation time, intraoperative blood loss and postoperative hospital stays were significantly higher in the manual group than that in the mechanical group. The R0 resection rate and the tumor characteristics were not significantly different between groups. There was no significant difference in overall survival and disease-free survival between the two groups.

Conclusion

The mechanical anastomosis technology adopted by this study was shown to be a safer and more effective procedure with similar survival comparable to that of manual anastomosis for the HPCECs patients.

Revisiting the gastric pull-up for pharyngoesophageal reconstruction: A systematic review and meta-analysis of mortality and morbidity

Gastric pull-up (GPU) is among the oldest techniques for reconstructing the pharyngoesophageal junction following cancer resection. This review examines morbidity and mortality rates following GPU pharyngoesophageal junction reconstruction from 1959 until present: 77 studies, 2,705 patients. The odds of mortality, anastomotic complications, and other complications decreased by 37.2% (95%CI = 28.0-45.3%; P < 0.0001), 8.0% (95%CI = -2.1 to 17.1%; P = 0.12), 21.0% (95%CI 3.5-35.2%; P = 0.021) per decade respectively. J. Surg. Oncol. 2016;114:907-914. © 2016 Wiley Periodicals, Inc.

Reconstruction of the hypopharynx: current trends

PURPOSE OF REVIEW

Reconstruction of the hypopharynx continues to present a clinical challenge for the reconstructive surgeon. Trends continue to evolve as many viable options exist, depending on individual patient characteristics and institutional preferences. The article reviews the most current literature available on the subject.

RECENT FINDINGS

Surgical resections resulting in pharyngoesophageal defects require timely reconstruction to minimize patient morbidity while optimizing quality of life, specifically in regards to speech and swallowing. Contemporary reconstructive options include various gastrointestinal flaps, pedicled myocutaneous flaps, and fasciocutaneous free flaps. Institutional trends often depend on the availability, training, and expertise of the reconstructive surgeon. The current options available differ in their complication rate and overall morbidity, and must take into account each patient's general medical health. Increased availability of surgeons trained in microvascular reconstruction and the continued high published success rates have made free flaps an attractive option for hypopharyngeal reconstruction. Functional outcome regarding swallowing and speech rehabilitation after free flap reconstruction is promising.

SUMMARY

With continued publication of overall high success rates coupled with superior functional outcome and increased availability of surgeons trained in microvascular reconstruction, fasciocutaneous free flap reconstruction of the hypopharynx will probably surpass intestinal flaps in reliability and popularity.