Gastric Pull-up Reconstruction for Radical Pharyngolaryngectomy in Advanced Hypopharyngeal Cancer Patients.
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(5) S69. 4. 40% 62. 89% [14] 62.5% 91.7% [16]. 10 50%. (6%. (. 7%). (15%) [15]. 3). 1. Ho CM, Ng WF, Lam KH, et al. Submucosal tumor extension in hypopharyngeal cancer. Arch Otolaryngol Head Neck Surg 1997;123:959-65 2. Spriano G, Pellini R, Roselli R. Pectoralis major myocutaneous flap for hypopharyngeal reconstruction. Plast Reconstr Surg 2002;110:1408-13. 3. Ay s h f o r d C A , Wa l s h R M , Wa t k i n s o n J C . Reconstructive techniques currently used following resection of hypopharyngeal carcinoma. J Laryngol Otol 1999;113:145-8. 4. Genden EM, Kaufman MR, Katz B, et al. Tubed gastro-. omental free flap for pharyngoesophageal reconstruction. Arch Otolaryngol Head Neck Surg 2001;127:847-53. 5. Triboulet JP, Mariette C, Chevalier D, et al. Surgical management of carcinoma of the hypopharynx and the cervical esophagus: analysis of 209 cases. Arch Surg 2001;136:1164-70. 6. Jones AS, Roland NJ, Hamilton J, et al. Malignant tumors of the cervical esophagus. Clin Otolaryngol 1996;21:49-53. 7. Cahow CE, Sasaki CT. Gastric pull-up reconstruction for pharyngo-laryngo-esophagectomy. Arch Surg 1994;129:425-9. 8. Sasaki CT, Salzer SJ, Cahow E, et al. Laryngopharyngoesophagectomy for advanced hypopharyngeal and esophageal squamous cell carcinoma: the Yale experience. Laryngoscope 1995;105:160-3. 9. Spector JG, Session DG, Hanghey BH, et al. Delayed regional metastases, distant metastases, and second primary malignancies in squamous cell carcinomas of the larynx and hypopharynx. Laryngoscope 2001;111: 1079-87. 10. Wei WI. The dilemma of treating hypopharyngeal carcinoma: more or less: Hayes Martin Lecture. Arch Otolaryngol Head Neck Surg 2002;128:229-32. 11. Martins AS. Multicentricity in pharyngoesophageal tumors: argument for total pharyngolaryngoesophagectomy and gastric transposition. Head Neck 2000;22:156-63. 12. Kagei K, Hosokawa M, Shirato H, et al. Efficacy of intense screening and treatment for synchronous second primary cancers in patients with esophageal cancer. Jpn J Clin Oncol 2002;32:120-7. 13. Spriano G, Piantanida R, Pellini R. Hypopharyngeal reconstruction using pectoralis major myocutaneous flap and pre-vertebral fascia. Laryngoscope 2001;111: 544-7. 14. Martins AS. Gastric transposition for pharyngolaryngooesophageal cancer: the Unicamp experience. J Laryngol Otol 2000;114:682-9. 15. Ullah R, Bailie N, Kinsella J, et al. Pharyngo-laryngoesophagectomy and gastric pull-up for post-cricoid and cervical esophageal squamous cell carcinoma. J Laryngol Otol 2002;116:826-30. 16. Hartley BE, Bottrill ID, Howard DJ. A third decade's experience with the gastric pull-up operation for hypopharyngeal carcinoma: changing patterns of use. J Laryngol Otol 1999;113:241-3..
(6) S70. Gastric Pull-up Reconstruction for Radical Pharyngolaryngectomy in Advanced Hypopharyngeal Cancer Patients 1. 1. Chun-Hung Hua, Chien-Chih Chen, Ming-Hsui Tsai, Chih-Shiun Shih , Nan-Yung Hsu 1. Deaprtment of Otorhinolaryngology and Division of Chest Surgery, China Medical University Hospital, Taichung, Taiwan, R.O.C.. Objectives. Radical pharyngolaryngectomy with neck lymph node dissection is a common procedure for patients with advanced hypopharyngeal cancer. Preoperative or postoperative radiotherapy is often necessary for this group of patients and as a result, the rate of complications is as high as 78%, while the mortality rate can reach 8%. Therefore, head and neck surgeons are in need of a reliable pharyngolaryngeal reconstructive surgical technique which will reduce the surgical and postradiation complications. Methods. We retrospectively investigated 42 patients with advanced hypopharyngeal cancer who received radical pharyngolaryngectomy from March 1995 to October 2002. Ten of the patients received esophagus resection and gastric pull-up reconstruction. Fifteen patients received pectoralis major myocutaneous flap (PMMCF) reconstruction. The rest of the patients (17) received primary mucosal closure of the pharyngeal defect. We analyzed the differences in intraoperative and postoperative complications, success rate of the reconstructed flap, hospitalization duration and swallowing function between the groups of patients who received gastric pull-up reconstruction and those who received PMMCF reconstruction. Results. The average age of patients who received gastric pull-up reconstruction was 57.7 years. The rate of postoperative pharyngocutaneous fistula and surgical wound infection for patients who underwent gastric pull-up was about 40% (4/10), compared with 53% for the PMMCF reconstruction group (8/15). The average duration of hospitalization for the gastric pull-up group was 22.4 days, compared with 31 days for the PMMCF reconstruction group. Solid food consumption was achieved in 50% of the gastric pull-up group, while it was achieved in only 20% of the PMMCF group. Flap reconstruction was successful in both groups. In the gastric pull-up group, second primary esophageal cancer was found in three of the patients. In the PMMCF reconstruction group, second primary soft palate cancer was found in one patient. In pharyngolaryngectomy with PMMCF reconstruction, esophageal specimens are not taken; therefore, we could not assess whether any second primary esophageal cancer was present. C o n c l u s i o n s . Gastric pull-up reconstruction is suitable for patients who receive radiotherapy before the operation or have limited residual healthy mucosa of the posterior pharyngeal wall. It is also suitable for patients with coexisting esophageal cancer. Therefore, gastric pull-up for reconstruction of post- pharyngolaryngecomy defects is a reliable choice for patients with advanced hypopharyngeal cancer. The procedure produces few complications and good postoperative swallowing results. ( Mid Taiwan J Med 2003;8 Supplment:S65-70 ) Key words gastric pull up, hypopharyngeal cancer, pectoralis major myocutaneous flap. Received : May 14, 2003.. Revised : July 8, 2003.. Accepted : July 15, 2003. Address reprint requests to : Ming-Hsui Tsai, Department of Otolaryngology, China Medical University Hospital, 2 Yuh-Der Road, Taichung 404, Taiwan..
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