Reconstruction of the laryngopharynx and cervical esophagus

The historical evolution of reconstruction of the cervical esophagus and laryngopharynx over the past 100 years is documented. The impact of these technical achievements is contrasted to the failure to improve the 5-year survival rate of 24%. While the clinician awaits new protocols of treatment to improve survival statistics, the thrust of the surgical oncologist is to develop a reliable method of reconstruction which meets specific minimal criteria. The following objectives should be achieved: Reconstruction should not limit the effectiveness of the ablative technique. Short hospitalization and one stage techniques are superior. Technique mortality and morbidity must be low. A 10-year institutional study using the Montgomery 2-stage technique is presented. In contrast, comparative literature data analysis of all methods of laryngopharyngocervical reconstruction indicates that single stage techniques offer a greater advantage. This study suggests that visceroplasty (stomach), free jejunal transfer, and single stage reconstruction, using the pectoralis myocutaneous flap, approach the previously established criteria more effectively than others. A new technique (1-stage), using partial tubulation of the pectoralis major myocutaneous flap, is recommended for regional reconstruction of the cervical esophagus and pharynx. In order to decrease the pressure and torsion on the vascular pedicle of the pectoralis major myocutaneous flap and increase its predicted length, partial resection of the ipsilateral clavicle is proposed.