Results of Pharyngeal Reconstruction After Total Laryngectomy in Hypopharyngeal Cancer: A 12-year Experience in Srinagarind Hospital
Keywords:
pharyngeal reconstruction, laryngectomy, hypopharyngeal cancer, gastric pull-upAbstract
Background and objective: Pharyngeal reconstruction after total laryngectomy in hypopharyngeal cancer is the challenge issue for head and neck surgeon. Srinagarind Hospital performed this procedure for a long time but it has never been studied about its results. We aim to evaluate the results.
Methods: This descriptive study collected data of patients who were diagnosed as hypopharyngeal cancer and underwent total laryngectomy which the pharyngcal defect couldn’t be repaired by primary suture. We included patients from January 1st, 1997 to October 31st, 2009. The main data consisted of incidence of postoperative pharyngeal leakage, date of start oral feeding and length of hospital stay.
Results: There were 26 cases included. Twenty three patients were reconstructed by gastric pull-up and 4 cases (17.4%) had postoperative pharyngeal leakage. The other 3 cases were reconstructed by pectoralis major myocutaneous flap (PMMF) and 2 cases (66.6%) had postoperative pharyngeal leakage. Three out of 6 cases who had pharyngeal leakage were resolved by conservative treatment while the others required surgical intervention. Other complications included mainly pulmonary complications. However there was no intraabdominal complication in this study. Average days which patient could start oral feeding and length of hospital stay were 24 days and 84.33 days in leakage group as compared with 12.65 days and 28.45 days in non-leakage group, respectively. However, our study could not analyze the factors which influence the risk of postoperative pharyngeal leakage.
Conclusion: Incidence of pharyngeal leakage in case of pharyngeal reconstruction after total laryngectomy in hypopharyngeal cancer was 17.4% in cases whom underwent gastric pull-up and 66.6% whom underwent PMMF. There were only 50% of pharyngeal leakage-patients resolve by conservative treatment. The others required surgical procedure.
