Abstract
We reviewed 35 cases of cervical esophageal reconstruction following total laryngopharyngectomy for advanced cancer at Hiroshima University Medical School (1980-1992). The incidence rates and causative factors of complications after pharyngo-esophageal reconstruction were analysed statistically. We used gastric tubes (2/35), deltopectoral (DP) flaps (14/35), and pectoralis major myocutaneous (PM-MC) flaps (19/35) for the esophageal reconstructions. Post-operative complications developed in 17 cases, such as flap necrosis, stenosis at the esophageal flap junction, and delayed fistulization. Four of these required readvancements of the DP and PM-MC flaps. The factors that could predispose for flap complications are age, preoperative radiation dose, choice of DP or PM-MC flap and the general condition of a patient. However, these factors did not show a significant positive correlation to the incidence rates of the complications in our study.
We found that site of the fistulae depended on the type of flap. In the case of DP flaps, the fistulae tended to occur at the site of the suture between the host skin and the flap as the bottom of the secondly reconstructed cervical esophagus. On the other hand, in the case of PM-MC flaps the site of the fistulae tended to be at the suture between the esophageal or pharyngeal mucosa and the flap skin.
