Reconstruction after laryngopharyngectomy: free-jejunal autograft versus gastric pull-up

ABSTRACT

Treatment of carcinoma of the hypopharynx and cervical esophagus is challenging as regards both cure and palliation. Many alternative methods for restoring the continuity of the alimentary tract were tested. These methods could be classified into two broad categories locoregional skin or myocutaneous units, and free or pedicled enteric substitutes. Recent development in the techniques of microvascular anastomosis introduced the free jejunum autograft as a method of pharyngoesophageal reconstruction comparable to the stomach pull-up in achieving the goals of speed, safety, and effectiveness of rehabilitation. Fifteen patients with hypopharyngeal carcinoma were treated surgically at the National Cancer Institute [NCI] by the free- jejunal autograft technique. These patients were compared to thirty patients who had reconstruction by the gastric pull-up technique. The use of jejunal reconstruction for high lesions, early confined lesions, elderly patients, and patients with poor cardiopulmonary reserve were advocated. For lesions that invade the esophagus and for free transplant failure, stomach pull-up is recommended