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Esophageal reconstruction after oncological total laryngopharyngoesophagectomy: Algorithmic approach
Author(s) -
Chang TzuYen,
Hsiao JennRen,
Lee WeiTing,
Ou ChunYen,
Yen YiTing,
Tseng YauLin,
Pan ShinChen,
Shieh ShyhJou,
Lee YaoChou
Publication year - 2019
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.30304
Subject(s) - medicine , swallowing , surgery , anastomosis , head and neck , free flap
Background Reconstruction for total laryngopharyngoesophagectomy is accomplished mainly by gastrointestinal transposition but can be complicated by anastomotic tension or associated neck‐skin defect. Here, we present the results of total esophageal reconstruction by gastrointestinal transposition alone or with additional free tissue transfer and propose an algorithm accordingly. Methods We reviewed patients who had oncologic total laryngopharyngoesophagectomy between January 2012 and January 2016. Twenty‐four men and one woman were included with a mean age of 54 (range, 41–72) years. Patients were grouped by reconstruction into the gastric pull‐up (GP, n = 15), colon interposition (CI, n = 2), GP combined with free jejunal flap (GPFJ, n = 6), or GP combined with anterolateral thigh flap (GPALT, n = 2) group to compare clinical outcomes. Results The mean operation time was 1037.3 minutes and was significantly longer in the GPALT group than in the GP group (1235.0 ± 50.0 minutes vs. 929.7 ± 137.7 minutes, p =.009). All flaps survived. After a mean follow‐up of 18 months, the overall leakage, stricture, and successful swallowing rates were 44%, 4%, and 76%, respectively. There was no significant difference in the leakage (53.3%, 50.0%, 16.7%, and 50.0%, p =.581), stricture (6.7%, 0%, 0%, and 0%, p = 1.000), or successful swallowing (73.3%, 50.0%, 83.3%, and 100%, p =.783) rates between GP, CI, GPFJ, and GPALT groups, respectively. Conclusions The proposed algorithm that ranks gastric pull‐up as a priority and uses additional free tissue transfer to overcome the anastomotic tension or associated neck‐skin defect is feasible.