Gastric Pull-Up Reconstruction for Advanced Hypopharyngeal Cancer

Hypopharyngeal squamous cell carcinoma (SCC) is an aggressive disease typically diagnosed at advanced stages. Resection of tumors extending to the cervical esophagus requires total pharyngolaryngoesophagectomy, and reconstruction of these complex defects remains challenging. Gastric pull-up (GPU) reconstruction provides a single-stage, well-vascularized conduit but carries significant morbidity, particularly in previously irradiated fields.

A retrospective cohort of 124 patients underwent total laryngopharyngoesophagectomy with GPU reconstruction for advanced hypopharyngeal SCC between 1998 and 2023. Patients were grouped by treatment context: primary surgery with adjuvant therapy (n=51) and salvage surgery after failed nonsurgical treatment (n=73). Primary outcomes included 24-month disease-free survival (DFS), pharyngocutaneous fistula (PCF) rate, oral diet tolerance, and gastrostomy tube dependence.

At 24 months, DFS was 49.0% in the primary cohort and 35.6% in the salvage cohort (P=0.144). PCF occurred in 35.3% and 56.2% of patients, respectively (P=0.028). At 6 months, 60.7% of primary and 26.0% of salvage patients were gastrostomy tube-free. Stricture requiring dilation was common, particularly after high-dose or repeat radiotherapy.

Gastric pull-up reconstruction remains a reliable method for restoring pharyngoesophageal continuity after extensive hypopharyngeal SCC resection, achieving acceptable oncologic outcomes. However, prior radiation markedly increases PCF rates and delays functional recovery. Optimized preoperative nutrition, endocrine assessment, and vascularized flap reinforcement are critical to improve outcomes in this high-risk population.