Combined use of gastric pull-up and pectoralis major flaps for massive defects after total laryngopharyngoesophagectomy in patients with advanced hypopharyngeal carcinoma

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• 作者：Caiyun Zhang ; Shicai Chen ; Minhui Zhu…
• 关键词：Hypopharyngeal cancer ; Radical surgery ; Gastric pull ; up ; Pectoralis major flap
• 刊名：European Archives of Oto-Rhino-Laryngology
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：272
• 期：11
• 页码：3557-3564
• 全文大小：970 KB
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• 作者单位：Caiyun Zhang (1)
  Shicai Chen (1)
  Minhui Zhu (1)
  Donghui Chen (1)
  Hezhong Chen (2)
  Hongliang Zheng (1)
  
  1. Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
  2. Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Otorhinolaryngology
  Neurosurgery
  Head and Neck Surgery
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1434-4726

文摘

Reconstruction for patients with advanced squamous cell carcinoma of the hypopharynx (SCCHP) after radical surgery is a challenge for head and neck surgeons, especially when one flap alone cannot entirely cover the defects. In this report, we describe the successful use of gastric pull-up combined with pectoralis major flaps for single-stage reconstruction after total laryngopharyngoesophagectomy in patients with SCCHP. We retrospectively reviewed the records of 23 patients with stage IV SCCHP who underwent this reconstructive procedure. Surgical details and perioperative morbidity were described, and functional and oncologic outcomes were evaluated. We used the gastric pull-up and pectoralis major flap procedure to reconstruct the defects for all 23 patients. In 13 patients the combined flaps were used to restore intestinal continuity, and in 10 patients the defects were repaired using gastric pull-up alone and covered by the pectoralis major flap. All the combined flaps worked well, and patients recovered normal swallowing function a mean 19.6 days after surgery. After an overall mean follow-up time of 25.3 months, six patients were still alive at the time of this analysis with no evidence of disease. Our results indicate that for patients with advanced SCCHP after total laryngopharyngoesophagectomy, using a pectoralis major flap combined with gastric pull-up enables one-stage reconstruction even when gastric pull-up alone cannot restore intestinal continuity. Furthermore, the functional and oncologic outcomes from this study suggest that this reconstructive procedure is safe and reliable, and more patients with advanced disease could be considered. Keywords Hypopharyngeal cancer Radical surgery Gastric pull-up Pectoralis major flap