[Strategy in the treatment of hypopharyngeal and cervical esophageal carcinoma]

Modified distal anastomosis between colon and thoracic esophagus for hypopharynx reconstruction using free colon flap: A comparison study

BACKGROUND

Free colon flap is the preferred method of hypopharynx reconstruction when the defect is substantial, or simultaneous voice reconstruction is planned. Most of the complications in free colon flaps are located at the anastomosis between colon and thoracic esophagus due to size mismatch of the lumen. We present our experience comparing a modified anastomosis technique and a conventional anastomosis technique at the distal end of interposed colonic segment.

METHODS

In this retrospective review, 94 patients, divided into two groups, underwent hypopharynx reconstruction. Group A (18 patients), conventional anastomoses between colon and thoracic esophagus was performed, while in Group B (76 patients), underwent the modified method of anastomosis.

RESULTS

The average follow-up period was 46 months in group A and 54 months in group B. Fistula formation was found in 2 patients from Group A, and 1 patient from Group B. Strictures were observed in 4 patients from Group A, and 1 patient from Group B. Difference between both groups regarding complications of leakage and stricture formation was statistically significant (p < 0.05).

CONCLUSION

Modified method for anastomosis between colon and thoracic esophagus was found to be effective in the reduction of complications associated with the use of a free colon flap for hypopharyngeal reconstruction. Further advances of this technique could gain momentum in the future.

Gastric pull-up reconstruction for the hypopharyngeal and cervical esophageal carcinoma in small thoracic unit

The objective of this article is to review results of one surgical team for gastric pull-up reconstruction for carcinoma of the hypopharynx and cervical esophagus after pharyngolaryngo-esophagectomy in small thoracic unit. Between July, 2004 and December 2005, four patients underwent pharyngolaryngo-esophagectomy and gastric pull-up reconstruction for carcinoma of hypopharynx and esophagus. There were three female and one male patient with average age at the time of surgery 47 years. The study analyzed complications and mortality in early postoperative period after resections of the carcinoma. Squamous cell cancer in all patients was confirmed. There was no in-hospital mortality and non-fatal complications were occurred in 3 patients. It was recorded two year survival for two patients. Pharyngolaryngo-esophagectomy and gastric pull-up reconstruction can be performed for the patients with carcinoma of the hypopharynx and cervical esophagus with an acceptable operative mortality and morbidity rate even in small thoracic unit. Long term survival despite good early postoperative results still remains poor.