TY - JOUR
T1 - Pharyngoesophageal reconstruction outcomes following 349 cases
AU - Selber, Jesse C.
AU - Xue, Amy
AU - Liu, Jun
AU - Hanasono, Matthew M.
AU - Skoracki, Roman J.
AU - Chang, Edward I.
AU - Yu, Peirong
N1 - Publisher Copyright:
© 2014 by Thieme Medical Publishers, Inc.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2014/11/1
Y1 - 2014/11/1
N2 - Abstract Background Pharyngoesophageal (PE) reconstruction is complex, with a diverse set of reconstructive considerations. This large series examines the impact of various defect characteristics and reconstructive modalities on outcomes. Patients and Methods A retrospective review identified 349 cases from 2000 to 2011. Patients were grouped according to defect extent and location. Groups were compared by comorbidities, flap type, donor and recipient site complications, postoperative diet, and tracheoesophageal speech. Results Of 349 cases, 193 (55.3%) PE defects were circumferential and 156 (44.7%) were partial. The majority of defects resulted from laryngopharyngectomy (72.5%), most reconstructed with the anterolateral thigh flap (60%). There were 15.5% total esophagectomies, all of which received supercharged jejunal flaps. Of 349 patients, 81 patients (23.2%) had recipient site complications and 51 patients (14.6%) had donor site complications. The fistula rate trended higher in circumferential defects (11 vs. 6%, p=0.144), and the stricture rate was significantly higher (9.3 vs. 3.8%, p=0.044). In total, 302 patients (86.5%) had an oral diet after reconstruction, 64 (18%) of whom required supplemental tube feeds. Among 147 patients (42%) who received tracheoesophageal puncture (TEP), 19 (12.9%) eventually failed. Approximately 87% of patients with TEPs achieved fluent speech. The 5-year survival was low for all groups, ranging from 0 to 35%. Conclusions PE reconstruction can be performed safely, and most patients will achieve functional speech and swallowing. Swallowing function is worse when the larynx is removed, and the stricture rate is higher with circumferential defects. Specific technical measures can reduce the rate of common complications. Level of Evidence The level of evidence of this article was level III.
AB - Abstract Background Pharyngoesophageal (PE) reconstruction is complex, with a diverse set of reconstructive considerations. This large series examines the impact of various defect characteristics and reconstructive modalities on outcomes. Patients and Methods A retrospective review identified 349 cases from 2000 to 2011. Patients were grouped according to defect extent and location. Groups were compared by comorbidities, flap type, donor and recipient site complications, postoperative diet, and tracheoesophageal speech. Results Of 349 cases, 193 (55.3%) PE defects were circumferential and 156 (44.7%) were partial. The majority of defects resulted from laryngopharyngectomy (72.5%), most reconstructed with the anterolateral thigh flap (60%). There were 15.5% total esophagectomies, all of which received supercharged jejunal flaps. Of 349 patients, 81 patients (23.2%) had recipient site complications and 51 patients (14.6%) had donor site complications. The fistula rate trended higher in circumferential defects (11 vs. 6%, p=0.144), and the stricture rate was significantly higher (9.3 vs. 3.8%, p=0.044). In total, 302 patients (86.5%) had an oral diet after reconstruction, 64 (18%) of whom required supplemental tube feeds. Among 147 patients (42%) who received tracheoesophageal puncture (TEP), 19 (12.9%) eventually failed. Approximately 87% of patients with TEPs achieved fluent speech. The 5-year survival was low for all groups, ranging from 0 to 35%. Conclusions PE reconstruction can be performed safely, and most patients will achieve functional speech and swallowing. Swallowing function is worse when the larynx is removed, and the stricture rate is higher with circumferential defects. Specific technical measures can reduce the rate of common complications. Level of Evidence The level of evidence of this article was level III.
KW - anterolateral thigh flap
KW - head and neck reconstruction
KW - pharyngoesophageal reconstruction
KW - supercharged jejunem
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U2 - 10.1055/s-0034-1376887
DO - 10.1055/s-0034-1376887
M3 - Article
C2 - 24995392
AN - SCOPUS:84928942109
SN - 0743-684X
VL - 30
SP - 641
EP - 654
JO - Journal of Reconstructive Microsurgery
JF - Journal of Reconstructive Microsurgery
IS - 9
ER -