Hypopharynx reconstruction for primary hypopharyngeal carcinoma: a retrospective study and literature review

BACKGROUND: The study aims to retrospectively evaluate disparate reconstructive choices for defects in patients with primary hypopharyngeal carcinoma undergoing tumor resection. METHODS: One hundred and twenty-five patients of primary hypopharyngeal carcinamo conducted with hypopharynx reconstruction for restoring the defects causing by tumor ablation from 2003 to 2016 at Eye & ENT Hospital of Fudan University were reviewed. Most of them were treated with the following three techniques (n=115): gastric pull-up (GPU), the pedicled pectoralis major myocutaneous flap (PMMF) and the radial forearm free flap (RFFF). GPU was used for those with cervical esophagus invasion requiring esophageal resection in our institution. We focus on the postoperative complication morbidity, function of deglutition 1 month after hospital discharge and disease-free survival (DFS) outcomes. RESULTS: One month after operation, 56 of 65 (86.2%) achieved solid or semisolid diet with normal swallowing function for GPU, 8 of 12 (66.7%) for RFFF and 20 of 33 (60.6%) for PMMF respectively. Postoperative complications occured in 15 (23.1%), 8 (66.7%), 16 (48.5%) for GPU, RFFF and PMMF respectively, including flap/anastomotic necrsis, pharyngeal fistula, wound infection (both recipient and donor sites), pulmonary and cardiovascular complications. CONCLUSIONS: GPU showed satisfactory outcomes for reconstruction of patients with hypopharyngeal carcinoma requiring esophageal resection. For patients without cervical esophagus invasion and underwent partial or total pharyngectomy, both PMMF and RFFF can afford good coverage and reliable functional and survival outcome as well as postoperative complication morbidity. Moreover, the only predictive factor for incidence of postoperative complication was extent of surgery, as total hypopharyngectomy was more likely to develop complications after surgery than partial hypopharyngectomy.