Upper alimentary tract reconstruction after resection of hypopharyngeal and cervical esophageal cancers

OBJECTIVE To study the rationality and effectiveness of reconstruction methods for the defects after resection of the hypopharengeal and cervical esophageal cancers.METHODS The clinical data of 308 consecutive patients with hypopharyngeal and cervical esophageal cancers from 1985 to 2008 were retrospectively studied.There were 258 male and 50 female.The clinical diagnosis was 278 cases with hypopharyngeal cancer(pyriform sinus 224 cases,postcricoid 18 cases and posterior hypopharyngeal wall 36 cases)and 30 cases with cervical esophagealcancer.According to the classification of AJCC 2002,there were 19 cases in stage I,52 cases in stage II,117 cases in stage III and 120 cases in stage IV.All of the patients underwent surgical treatment.The upper alimentary tract were reconstructed by gastric pull-up,colon interposition,free jejunal interposition,free flap,pectoralis major myocutaneous flap,complex laryngo-trcheal myocutaneous flaps or hypopharyngeal mucosa.Fifty one patients preserved or reconstructed the voice function(included 36 patients with partial laryngectomy).RESULTS Two hundred and ninety eight of 308 cases resumed the oral diet soon after operation(96.7%).The voice function resumed or preserved in 51 cases(16.6%).Twenty one of 36 patients after partial laryngectomy were decannulated.Five cases(1.6%)were died in perioperative period.The operative complications included pharyngeal fistula and transplanting flaps lost occurred in 57 cases (18.5%).The 1,3,and 5 year survival rates were 79.6%,function.Freeflap is better than myocutaneous flap for the reconstruction of the defects after laryngectomy and hypopharyngectomy.60.2%and 40.7%respectively.CONCLUSION Up to now,extensive surgical resection and necessary upper alimentary tract reconstruction is the main method for hypopharyngeal and cervical esophageal cancers.Some cases can be reconstructed or preserved the voice