6. Evaluation of early results of surgical treatment for stage III and IV hypopharyngeal cancer with reconstruction using pectoralis major myocutaneous flaps
Main Article Content
Abstract
Treatment for stage III and IV hypopharyngeal cancer requires multimodal therapy. Surgery is an important method for controlling the disease locally and in the neck region. Our study includes 51 patients with stage III and IV hypopharyngeal cancer who underwent surgery and reconstruction using pectoralis major myocutaneous flaps at K Hospital from November 2020 to March 2022. The results showed that the most common site of cancer was the piriform sinus, accounting for 76.5%. Total laryngopharyngectomy was the most performed type of surgery, accounting for 58.8%. All pectoralis major flaps survived, with 5.9% of patients experiencing partial flap necrosis. The most common postoperative complication was pharyngocutaneous fistula, occurring in 15.7% of patients, which decreased to 5.9% after one month and 3.9% after three months. Factors increasing the risk of pharyngocutaneous fistula included blood albumin levels < 34 g/L (p = 0.005), preoperative radiation (p = 0.17), emergency tracheostomy (p = 0.237), BMI < 18.5 kg/m2 (p = 0.046), and blood hemoglobin levels < 130 g/L (p = 0.052).
Article Details
Keywords
Hypopharynx cancer, pectoralis major myocoutaneous flap
References
2. Cảnh PT, Châu LH. Tình hình ung thư thanh quản và ung thư hạ họng và kết quả điều trị tại khoa B1 Bệnh viện Tai Mũi Họng từ năm 1998 - 2002. Tạp chí Y học thực hành. 2010;713 (4):56 - 57.
3. Takes RP, Strojan P, Silver CE, et al. Current trends in initial management of hypopharyngeal cancer: the declining use of open surgery. Head & neck. Feb 2012;34(2):270-81. doi:10.1002/hed.21613
4. Habib A. Management of advanced hypopharyngeal carcinoma: systematic review of survival following surgical and non-surgical treatments. The Journal of laryngology and otology. May 2018;132(5):385-400. doi:10.1017/s0022215118000555
5. Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plastic and reconstructive surgery. Jan 1979;63(1):73-81. doi:10.1097/00006534-197901000-00012
6. Milenović A, Virag M, Uglesić V, et al. The pectoralis major flap in head and neck reconstruction: first 500 patients. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. Sep 2006;34(6):340-3. doi:10.1016/j.jcms.2006.04.001
7. Bradley PJ. Epidemiology of Hypopharyngeal Cancer. Advances in oto-rhino-laryngology. 2019;83:1-14. doi:10.1159/ 000492299
8. Wycliffe ND, Grover RS, Kim PD, et al. Hypopharyngeal cancer. Topics in magnetic resonance imaging: TMRI. Aug 2007;18(4):243-58. doi:10.1097/RMR.0b013e3181570c3f
9. Jones RF. The Paterson-Brown Kelly syndrome. Its relationship to iron deficiency and postcricoid carcinoma. I. The Journal of laryngology and otology. Jun 1961;75:529-43.
10. Pegan A, Rašić I, Košec A, et al. Type II hypopharyngeal defect reconstruction - a single institution experience. Acta clinica Croatica. Dec 2018;57(4):673-680. doi:10.20471/acc.20 18.57.04.10
11. Chu YH, Lai WS, Lin YY, et al. Pharyngeal reconstruction using a U-shaped pectoralis major myocutaneous flap: an effective technique that should not be forgotten. Eur Arch Otorhinolaryngol. Jan 2020;277(1):217-220. doi:10.1007/s00405-019-05643-x
12. Miyamoto S, Sakuraba M, Nagamatsu S, et al. Combined use of free jejunum and pectoralis major muscle flap with skin graft for reconstruction after salvage total pharyngolaryngectomy. Microsurgery. Feb 2013;33(2):119-24. doi:10.1002/micr.22017
13. Ben Hadj Yahia S, Vacher C, Guédon C. Anatomic study of the location of the thoracoacromial pedicle. Application to the pectoralis major musculocutaneous flap. Morphologie: bulletin de l’Association des anatomistes. Mar 2009;93(300):13-9.
14. Rikimaru H, Kiyokawa K, Inoue Y, et al. Three-dimensional anatomical vascular distribution in the pectoralis major myocutaneous flap. Plastic and reconstructive surgery. Apr 15 2005;115(5):1342-52; discussion 1353-4. doi:10.1097/01.prs.0000156972.66044.5c
15. Paydarfar JA, Birkmeyer NJ. Complications in head and neck surgery: a meta-analysis of postlaryngectomy pharyngocutaneous fistula. Archives of otolaryngology-head & neck surgery. Jan 2006;132(1):67-72. doi:10.1001/archotol.132.1. 67
16. Lansaat L, van der Noort V, Bernard SE, et al. Predictive factors for pharyngocutaneous fistulization after total laryngectomy: a Dutch Head and Neck Society audit. Eur Arch Otorhinolaryngol. Mar 2018;275(3):783-794. doi:10.1007/s00405-017-4861-8
17. Do SB, Chung CH, Chang YJ, et al. Risk Factors of and Treatments for Pharyngocutaneous Fistula Occurring after Oropharynx and Hypopharynx Reconstruction. Archives of plastic surgery. Nov 2017;44(6):530-538. doi:10.5999/aps.2017.00906
18. Marijić B, Grasl S, Grasl MC, et al. Do Salivary Bypass Tubes Reduce the Risk of Pharyngocutaneous Fistula after Laryngopharyngectomy-A Systematic Review and Meta-Analysis. Cancers (Basel). Jun 6 2021;13(11)doi:10.3390/cancers13112827
19. Leite AK, de Matos LL, Belli M, et al. Pectoralis major myocutaneous flap for head and neck reconstruction: risk factors for fistula formation. Acta otorhinolaryngologica Italica: organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale. Dec 2014;34(6):389-93.
20. Heng Y, Zhang D, Zhu X, et al. Hypopharynx reconstruction for primary hypopharyngeal carcinoma: a retrospective study and literature review. Translational cancer research. Jul 2021;10(7):3236-3247. doi:10.21037/tcr-20-2910