ABSTRACT
The objective of this cross sectional study was to assess the best option for reconstruction after pharyngolaryngectomy for hypopharyngeal carcinoma. The study was done in surgical oncology department. National Cancer Institute, Cairo University. The study included 131 patients with carcinoma of the hypopharynx. The results of this study showed that gastric pull-up was the suitable reconstructive option in 67.1% of cases with free jujenal flap reconstruction in 9.2%. No reconstruction teas done in 9.2% of advanced patients leaving the patient with a pharyngostome, an orostome and a tracheostomy. Pectoralis major myocutaneous flaps were used primarily for repair in 3.8% of patients, and free antrolateral thigh flap in 2.3% while primary closure was done in 8.4% of cases when conservative surgery was feasible. Postoperative morbidity was encountered in 47% of patients. The most common morbidities were pharyngeal fistula and chest infection. Local and nodal recurrence occurred in 19.1% of cases. Postoperative mortality occurred in 33% of cases. Of 81 cases there was an extrahypopharyngeal spread in 60% of them. Extension to the larynx occurred in 22% of cases, thyroid gland in 11% of cases, esophagus also in 11% of cases [all from postcricoid area], soft tissue extension in 11% of cases and oropharynx in 5% of cases. Pathological examination of nodes in cases subjected to lymph node dissection [53 cases,] revealed metastatic lymph nodes in 52.8%. Most of the cases were at advanced stage [48% of cases were stage IV and 35% of cases were stage III. Lack of sufficient safety margin was found in 15 cases [11.5%. All positive margins were less than 2 cm. According to the advanced stage of the disease at presentation, reconstruction by gastric pull-up after pharyngolaryng- esophagectomy for hypopharyngeal carcinoma is the optimal option