Abstract
Background Pharyngoesophageal (PE) reconstruction is complex, with a diverse set of reconstructive
considerations. This large series examines the impact of various defect characteristics
and reconstructive modalities on outcomes.
Patients and Methods A retrospective review identified 349 cases from 2000 to 2011. Patients were grouped
according to defect extent and location. Groups were compared by comorbidities, flap
type, donor and recipient site complications, postoperative diet, and tracheoesophageal
speech.
Results Of 349 cases, 193 (55.3%) PE defects were circumferential and 156 (44.7%) were partial.
The majority of defects resulted from laryngopharyngectomy (72.5%), most reconstructed
with the anterolateral thigh flap (60%). There were 15.5% total esophagectomies, all
of which received supercharged jejunal flaps. Of 349 patients, 81 patients (23.2%)
had recipient site complications and 51 patients (14.6%) had donor site complications.
The fistula rate trended higher in circumferential defects (11 vs. 6%, p = 0.144), and the stricture rate was significantly higher (9.3 vs. 3.8%, p = 0.044). In total, 302 patients (86.5%) had an oral diet after reconstruction, 64
(18%) of whom required supplemental tube feeds. Among 147 patients (42%) who received
tracheoesophageal puncture (TEP), 19 (12.9%) eventually failed. Approximately 87%
of patients with TEPs achieved fluent speech. The 5-year survival was low for all
groups, ranging from 0 to 35%.
Conclusions PE reconstruction can be performed safely, and most patients will achieve functional
speech and swallowing. Swallowing function is worse when the larynx is removed, and
the stricture rate is higher with circumferential defects. Specific technical measures
can reduce the rate of common complications.
Level of Evidence The level of evidence of this article was level III.
Keywords
pharyngoesophageal reconstruction - head and neck reconstruction - anterolateral thigh
flap - supercharged jejunem
