Reconstruction of hypopharyngeal defects in cancer surgery: do we have a choice?

Between 1982 and 1985, 83 patients with hypopharyngeal or extensive laryngeal cancers underwent pharyngoesophagectomy (48 patients), circumferential pharyngectomy (8 patients), and partial pharyngectomy (27 patients), depending on the site and extent of tumor involvement. The resultant hypopharyngeal defects were reconstructed with gastric transposition, a tubed pectoralis major myocutaneous flap, and a pectoralis major flap patch, respectively. There were three hospital deaths in the gastric transposition group (6 percent) and none in both pectoralis major flap groups. The leakage rate was 8.3 percent in the gastric transposition group, 25 percent in the tubed pectoralis major flap group, and 3.7 percent in the pectoralis major flap patch group. Stricture was avoided with the interdigitation technique used at the tubed-flap-to-esophagus anastomosis, although the fistula rate was high. The overall complication rate was higher with gastric transposition. Although swallowing was satisfactory in all three groups, 42 percent of the patients with gastric transposition experienced regurgitation. Over a follow-up period of 16 to 50 months the local recurrence rate was 5 percent, and the actuarial survival rate was 55 percent at 24 months.