The Usefullness of Gastric Pull-Up Reconstruction in Advanced Hypopharyngeal Cancer Surgery

Lee, Jin Woo; Oh, Se Joon; Lee, Jong Kil; Lee, Byung Joo; Lee, Jin Choon; Wang, Soo Geun

Abstract

BACKGROUND AND OBJECTIVES
Various methods of reconstruction have been used after resection of hypopharynx. This study is aimed to evaluate the results and usefullness of gastric pull-up reconstruction.
SUBJECTS AND METHOD
The clinical data of 12 hypopharyngeal cancer patients, who were treated with gastric pull-up primary surgery (9 patients, 75.0%) or with salvage surgery (3 patients, 25.0%) after radiotherapy with or without chemotherapy, were studiedfrom 1987 to 2002. This study was a retrospective review of 12 patients (8 males and 4 females, mean age 57.3 years).
RESULTS
Nine (75.0%) patients were stage IV and 3 (25.0%) patients were stage III. Total pharyngolaryngoesophagectomies were performed and reconstructed by gastric pullup. Five year survival rate was 57.7%. Five patients died of locoregional recurrence or distant metastasis and 3 patients were lost. The mean time forthe initiation of oral feeding was 32.2 days (range 23 to 58 days). Postoperative complications were hemothorax (1), fistula (2), stenosis (1), hypocalcemia (1), and regurgitation (2). There was no flap failure.
CONCLUSION
Although gastric pull-up after resection of advanced hypopharyngeal and cervical esophageal lesions has morbidity and mortality of a combined abdominal, thoracic and cervical operation, flap failure rate is relatively low compared with free flap reconstructions such as jejunal free flap, myocutaneous free flap (radial forearm free flap or anterolateral thigh free flap). Gastric transposition constitutes relatively safe and effective method of restoring the continuity of the upper digestive tract following surgery of extensive carcinoma of the hypopharynx, larynx, and cervical esophagus.