Abstract
Reconstruction after total pharyngo-esophagectomy has been a formidable challenge to head and neck surgeons. To clarify the advantages and disadvantages of different reconstructive methods after total pharyngo-esophagectomy, we retrospectively compared three methods of reconstruction from the point of view of blood loss, duration of surgery, complications, and functional results after surgery. Seventeen male patients with cancer of the hypopharynx or advanced cancer of the cervicothoracic esophagus with an age range from 54 to 72 years were included in this study. The reconstructive procedures consisted of gastric pull up (n=5), elongated gastric roll with micro-vascular anastomosis (n=7), and gastric pull up with free jejunal graft (n=5). There was no difference in the amount of blood loss or the average duration of surgery between each procedure. One case with gastric pull up developed a partial necrosis of the graft. In another case with gastric pull up with free jejunal graft, we found an anastomatic leakage. Although, no anastomatic leakage occurred in the cases with elongated gastric roll with micro-vascular anastomosis, complications related to resection were more frequent in these cases than in the other two procedures. One patient with elongated gastric roll with micro-vascular anastomosis and another patient with gastric pull up with free jejunal graft developed esophageal speech. These results suggest that there is no apparent difference amongst the three procedures and selection of the procedure should be done keeping in mind any associated systemic disease and/or the socio-economic condition of the patients who undergo total pharyngo-esophagectomy.
