Gastric pull-up vs deltopectoral flap for reconstruction of the cervical esophagus

Reconstruction of the cervical esophagus and pharynx after a total laryngopharyngectomy for patients with advanced hypopharyngeal cancer still remains a problem for surgeons. The results of two procedures, the tubed deltopectoral flap reconstruction and the gastric pull-up operation with pharyngogastric anastomosis, which are used in fulfilling postoperative deglutition requirements, were compared. There were nine patients in the gastric pull-up group and eight patients in the deltopectoral flap group. The groups were reasonably comparable with regard to age, sex, preoperative radiotherapy, and stage of tumor. Three of the patients in the gastric pull-up group were operated on for palliation alone. Average operation-to-swallow time was 12 days for the gastric pull-up groups and 90 days for the deltopectoral flap group. Reconstruction of the gullet with the stomach pull-up operations seems to be superior to the tubed deltopectoral flap. This is especially true if the operation is palliative because the patient is unlikely to survive more than one year after surgery.