13. Surgical outcomes of stage III, IVA and IVB hypopharyngeal cancer with esophageal invasion post reconstruction using free jejunal flap
Main Article Content
Abstract
Hypopharyngeal cancer invading the esophagus is a rare condition among cancers in the hypopharyngeal region. Multimodal treatment is required, with surgery being a critical component. This study involved 30 patients with stage III, IVA, and IVB hypopharyngeal cancer, invading either the esophagus opening or the cervical esophagus; patients underwent surgery with free jejunal flap reconstruction at K Hospital from October 2020 to March 2024. The results indicated that tumors most frequently originated from the pyriform sinus and the posterior hypopharyngeal wall, each accounting for 40% of cases, followed by the postcricoid region. Total laryngopharyngectomy with cervical esophagectomy was the most common surgical procedure, performed in 90% of cases. All free jejunal flaps survived, with partial necrosis occurring in 3.4% of patients. Postoperative pharyngeal fistula was observed in 3.4% of cases, with no abdominal complication reported. 66.7% of patients regained their oral intake after 10 days and 30% after 14 days.
Article Details
Keywords
Hypopharynx cancer, jejunal free flap
References
2. Henrys C, Slaughter T, Bernard A, Perry C, Porceddu S, Panizza B. Primary pharyngolaryngectomy with jejunal free flap reconstruction: a single centre’s evolving experience. ANZ journal of surgery. Oct 2020; 90(10): 1965-1969. doi:10.1111/ans.15930.
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. Wei WI, Chan JYW. Surgical Treatment of Advanced Staged Hypopharyngeal Cancer. Advances in oto-rhino-laryngology. 2019; 83:66-75. doi:10.1159/000492312.
6. Lei DP, Pan XL, Xu FL, et al. [Surgical treatment of hypopharyngeal cancer with cervical esophageal invasion]. Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery. Sep 2005; 40(9): 691-5.
7. Perez-Smith D, Wagels M, Theile DR. Jejunal free flap reconstruction of the pharyngolaryngectomy defect: 368 consecutive cases. Journal of plastic, reconstructive & aesthetic surgery: JPRAS. Jan 2013; 66(1): 9-15. doi:10.1016/j.bjps.2012.08.033.
8. Seidenberg B, Hurwitt ES. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Surgical forum. 1958; 9: 413-6.
9. Longmire WP, Jr. A modification of the Roux technique for antethoracic esophageal reconstruction. Surgery. Jul 1947; 22(1): 94-100.
10. Bradley PJ. Symptoms and Signs, Staging and Co-Morbidity of Hypopharyngeal Cancer. Advances in oto-rhino-laryngology. 2019; 83: 15-26. doi:10.1159/000492304.
11. Hoffman HT, Karnell LH, Shah JP, et al. Hypopharyngeal cancer patient care evaluation. The Laryngoscope. Aug 1997; 107(8): 1005-17. doi:10.1097/00005537-199708000-00001.
12. 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.
13. Kirchner JA. Pyriform sinus cancer: a clinical and laboratory study. The Annals of otology, rhinology, and laryngology. Nov-Dec 1975; 84(6): 793-803. doi:10.1177/000348947508400611.
14. Spector JG, Sessions DG, Emami B, et al. Squamous cell carcinoma of the pyriform sinus: a nonrandomized comparison of therapeutic modalities and long-term results. The Laryngoscope. Apr 1995; 105(4 Pt 1): 397-406. doi:10.1288/00005537-199504000-00012.
15. Ho CM, Ng WF, Lam KH, Wei WJ, Yuen AP. Submucosal tumor extension in hypopharyngeal cancer. Archives of otolaryngology--head & neck surgery. Sep 1997; 123(9): 959-65. doi:10.1001/archotol.1997.01900090073010.
16. Mauramati S, Morbini P, Ferrario G, et al. Morphological analysis of ischemia-reperfusion injury in a cold ischemia model of jejunal free flap for hypopharyngeal reconstruction. Journal of plastic, reconstructive & aesthetic surgery : JPRAS. Jan 2020; 73(1): 103-110. doi:10.1016/j.bjps.2019.07.004.
17. Nakatsuka T, Harii K, Asato H, Ebihara S, Yoshizumi T, Saikawa M. Comparative evaluation in pharyngo-oesophageal reconstruction: radial forearm flap compared with jejunal flap. A 10-year experience. Scandinavian journal of plastic and reconstructive surgery and hand surgery. Sep 1998; 32(3): 307-10. doi:10.1080/02844319850158651.
18. 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.2018.57.04.10.
19. Sharp DA, Theile DR, Cook R, Coman WB. Long-term functional speech and swallowing outcomes following pharyngolaryngectomy with free jejunal flap reconstruction. Annals of plastic surgery. Jun 2010; 64(6): 743-6. doi:10.1097/SAP.0b013e3181af3019.
20. Chan JY, Chow VL, Chan RC, Lau GI. Oncological outcome after free jejunal flap reconstruction for carcinoma of the hypopharynx. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. Jul 2012; 269(7): 1827-32. doi:10.1007/s00405-011-1836-z.