Recently, reconstruction using free jejunum autograft is usually performed after resection of hypopharyngeal and cervical esophageal carcinomas. Furthermore, when a tumor extends down into the thoratic esophagus, reconstruction is performed with the use of a jejunal autograft and a gastric tube after total pharyngo-laryngo-esophagectomy. However, sometimes primary reconstruction is impossible given the general condition of a patient and the condition of the reconstructed tissues.
Such a case with a hypopharyngeal carcinoma was discussed. A 77-year-old male underwent total pharyngo-laryngo-esophagectomy, but primary reconstruction of the pharynx was impossible since an upper part of his gastric tube had poor blood supply. Therefore, the upper end of the gastric tube was closed and embedded in the patient's neck after the blood supply was supercharged using microvascular anastomosis between the left gastroepiploic artery and the left transverse cervical artery. A gastric tube stoma was made at the neck after postoperative radiation therapy of 54 Gy. After these staged operations, a final reconstruction of the pharynx was made with the use of a pectoralis major myocutaneous flap. The postoperative swallowing function of the patient showed no problems, and no recurrent tumor was detected. This result suggests that this staged operation procedure is effective and should be applied in similar, limited cases.
