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Clinical outcomes following pharyngolaryngectomy reconstruction: a 20-year single-centre study

Published online by Cambridge University Press:  10 January 2022

T Layton Open the ORCID record for T Layton [Opens in a new window] ,
R Thomas ,
C Harris ,
S Holmes ,
L Fraser ,
P Silva  and
S C Winter
T Layton
Affiliation:
Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England Bleinheim Head and Neck Unit, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
R Thomas*
Affiliation:
Bleinheim Head and Neck Unit, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
C Harris
Affiliation:
Bleinheim Head and Neck Unit, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
S Holmes
Affiliation:
Bleinheim Head and Neck Unit, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
L Fraser
Affiliation:
Bleinheim Head and Neck Unit, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
P Silva
Affiliation:
Bleinheim Head and Neck Unit, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
S C Winter
Affiliation:
Bleinheim Head and Neck Unit, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
*
Author for correspondence: Mr Thomas Layton, Kennedy Institute of Rheumatology, NDORMS, University of Oxford, OxfordOX3 7FY, UK E-mail: [email protected]
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Abstract

Background

Advanced malignant neoplasms of the larynx and hypopharynx pose many therapeutic challenges. Total pharyngolaryngectomy and total laryngectomy provide an opportunity to cure these tumours but are associated with significant morbidity. Reconstruction of the pharyngeal defect following total pharyngolaryngectomy demands careful consideration and remains an area of debate within surgical discussions.

Methods

This paper describes a systemic analysis of pharyngeal reconstruction following total pharyngolaryngectomy and total laryngectomy, leveraging data collected over a 20-year period at a large tertiary referral centre.

Results

Analysing 155 patients, the results show that circumferential pharyngeal defects and prior radiotherapy have a significant impact on surgical complications. In addition, free tissue transfer in larger pharyngeal defects showed lower rates of post-operative anastomosis leak and stricture.

Conclusion

Pharyngeal resection carries a substantial risk of post-operative complications, and free tissue transfer appears to be an effective means of reconstruction for circumferential defects.

Keywords

OtolaryngologyHead And Neck CancerOutcomes Research
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 11 , November 2022 , pp. 1105 - 1112
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Mr T Layton takes responsibility for the integrity of the content of the paper

References

Sharaf, B, Xue, A, Solari, MG, Boa, O, Liu, J, Hanasono, MM et al. Optimizing outcomes in pharyngoesophageal reconstruction and neck resurfacing: 10-year experience of 294 cases. Plast Reconstr Surg 2017;139:105–19CrossRefGoogle ScholarPubMed
Nagel, TH, Hayden, RE. Advantages and limitations of free and pedicled flaps in reconstruction of pharyngoesophageal defects. Curr Opin Otolaryngol Head Neck Surg 2014;22:407–13CrossRefGoogle ScholarPubMed
Yu, P, Lewin, JS, Reece, GP, Robb, GL. Comparison of clinical and functional outcomes and hospital costs following pharyngoesophageal reconstruction with the anterolateral thigh free flap versus the jejunal flap. Plast Reconstr Surg 2006;117:968–74CrossRefGoogle ScholarPubMed
Bonomi, MR, Blakaj, A, Blakaj, D. Organ preservation for advanced larynx cancer: a review of chemotherapy and radiation combination strategies. Oral Oncol 2018;86:301–6CrossRefGoogle ScholarPubMed
Patel, SA, Qureshi, MM, Dyer, MA, Jalisi, S, Grillone, G, Truong, MT. Comparing surgical and nonsurgical larynx-preserving treatments with total laryngectomy for locally advanced laryngeal cancer. Cancer 2019;125:3367–77CrossRefGoogle ScholarPubMed
Clark, JR, Gilbert, R, Irish, J, Brown, D, Neligan, P, Gullane, PJ. Morbidity after flap reconstruction of hypopharyngeal defects. Laryngoscope 2006;116:173–81CrossRefGoogle ScholarPubMed
Nouraei, SA, Dias, A, Kanona, H, Vokes, D, O'Flynn, P, Clarke, PM et al. Impact of the method and success of pharyngeal reconstruction on the outcome of treating laryngeal and hypopharyngeal cancers with pharyngolaryngectomy: a national analysis. J Plast Reconstr Aesthet Surg 2017;70:628–38CrossRefGoogle ScholarPubMed
Moradi, P, Glass, GE, Atherton, DD, Eccles, S, Coffey, M, Majithia, A et al. Reconstruction of pharyngolaryngectomy defects using the jejunal free flap: a 10-year experience from a single reconstructive center. Plast Reconstr Surg 2010;126:1960–6CrossRefGoogle ScholarPubMed
Karri, V, Yang, M-C, Chung, K-P, Chen, S-H, Mardini, S, Chen, H-C. Total pharyngolaryngectomy and voice reconstruction with ileocolon free flap: functional outcome and quality of life. J Plast Reconstr Aesthet Surg 2011;64:911–20CrossRefGoogle ScholarPubMed
Microvascular Committee of the American Academy of Otolaryngology – Head & Neck Surgery. Salvage laryngectomy and laryngopharyngectomy: multicenter review of outcomes associated with a reconstructive approach. Head Neck 2019;41:16–29CrossRefGoogle Scholar
Deleyiannis, FW, Weymuller, EA Jr, Coltrera, MD, Futran, N. Quality of life after laryngectomy: are functional disabilities important? Head Neck 1999;21:319–243.0.CO;2-H>CrossRefGoogle ScholarPubMed
Clark, JR, de Almeida, J, Gilbert, R, Irish, J, Brown, D, Neligan, P et al. Primary and salvage (hypo)pharyngectomy: analysis and outcome. Head Neck 2006;28:671–7CrossRefGoogle ScholarPubMed
Denewer, A, Khater, A, Hafez, MT, Hussein, O, Roshdy, S, Shahatto, F et al. Pharyngoesophageal reconstruction after resection of hypopharyngeal carcinoma: a new algorithm after analysis of 142 cases. World J Surg Oncol 2014;12:182CrossRefGoogle ScholarPubMed
Broome, M, Juilland, N, Litzistorf, Y, Monnier, Y, Sandu, K, Pasche, P et al. Factors influencing the incidence of severe complications in head and neck free flap reconstructions. Plast Reconstr Surg Glob Open 2016;4:e1013CrossRefGoogle ScholarPubMed
Lewin, JS, Barringer, DA, May, AH, Gillenwater, AM, Arnold, KA, Roberts, DB et al. Functional outcomes after laryngopharyngectomy with anterolateral thigh flap reconstruction. Head Neck 2006;28:142–9CrossRefGoogle ScholarPubMed
Murray, DJ, Gilbert, RW, Vesely, MJ, Novak, CB, Zaitlin-Gencher, S, Clark, JR et al. Functional outcomes and donor site morbidity following circumferential pharyngoesophageal reconstruction using an anterolateral thigh flap and salivary bypass tube. Head Neck 2007;29:147–54CrossRefGoogle ScholarPubMed
Ward, EC, Bishop, B, Frisby, J, Stevens, M. Swallowing outcomes following laryngectomy and pharyngolaryngectomy. Arch Otolaryngol Head Neck Surg 2002;128:181–6CrossRefGoogle ScholarPubMed
Siddiq, S, Paleri, V. Outcomes of tumour control from primary treatment of hypopharyngeal cancer. Adv Otorhinolaryngol 2019;83:90–108Google ScholarPubMed
van Brederode, TD, Halmos, GB, Stenekes, MW. Functional outcome after one-stage flap reconstruction of the hypopharynx following tumor ablation. Eur Arch Otorhinolaryngol 2017;274:969–76CrossRefGoogle ScholarPubMed
Zelken, JA, Kang, CJ, Huang, SF, Liao, CT, Tsao, CK. Refinements in flap design and inset for pharyngoesophageal reconstruction with free thigh flaps. Microsurgery 2017;37:112–18CrossRefGoogle ScholarPubMed
Sagar, B, Marres, HA, Hartman, EH. Hypopharyngeal reconstruction with an anterolateral thigh flap after laryngopharyngeal resection: results of a retrospective study on 20 patients. J Plast Reconstr Aesthet Surg 2010;63:970–5CrossRefGoogle ScholarPubMed
Murray, DJ, Novak, CB, Neligan, PC. Fasciocutaneous free flaps in pharyngolaryngo-oesophageal reconstruction: a critical review of the literature. J Plast Reconstr Aesthet Surg 2008;61:1148–56CrossRefGoogle ScholarPubMed
Hanasono, MM. Reconstructive surgery for head and neck cancer patients. Adv Med 2014;2014:7954–83CrossRefGoogle ScholarPubMed
Kubo, T, Seike, S, Kiya, K, Tomita, K, Hosokawa, K. Salvage treatment of failed free jejunal flap transfer: our experiences and literature review. Plast Reconstr Surg Glob Open 2018;6:e1889CrossRefGoogle ScholarPubMed
Kao, H-K, Abdelrahman, M, Chang, K-P, Wu, C-M, Hung, S-Y, Shyu, VB-H. Choice of flap affects fistula rate after salvage laryngopharyngectomy. Sci Rep 2015;5:9180–90CrossRefGoogle ScholarPubMed
Scharpf, J, Esclamado, RM. Reconstruction with radial forearm flaps after ablative surgery for hypopharyngeal cancer. Head Neck 2003;25:261–6CrossRefGoogle ScholarPubMed
Dindo, D, Demartines, N, Clavien, P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:261–6CrossRefGoogle Scholar
Schwartz, AW. Dr. Theodor Billroth and the first laryngectomy. Ann Plast Surg 1978;1:513–16CrossRefGoogle Scholar
Carsuzaa, F, Capitaine, A-L, Ferrié, J-C, Apert, V, Tonnerre, D, Frasca, D et al. Pharyngocutaneous fistulas after total laryngectomy or pharyngolaryngectomy: place of video-fluoroscopic swallowing study. Head Neck 2020;42:3638–46CrossRefGoogle ScholarPubMed
Mahalingam, S, Srinivasan, R, Spielmann, P. Quality-of-life and functional outcomes following pharyngolaryngectomy: a systematic review of literature. Clin Otolaryngol 2016;41:25–43CrossRefGoogle ScholarPubMed
Terlingen, LT, Pilz, W, Kuijer, M, Kremer, B, Baijens, LW. Diagnosis and treatment of oropharyngeal dysphagia after total laryngectomy with or without pharyngoesophageal reconstruction: systematic review. Head Neck 2018;40:2733–48CrossRefGoogle ScholarPubMed
Esteller, E, Vega, MC, López, M, Quer, M, León, X. Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy. Eur Arch Otorhinolaryngol 2011;268:295–301CrossRefGoogle ScholarPubMed
Bossi, P, Alfieri, S, Strojan, P, Takes, RP, López, F, Mäkitie, A et al. Prognostic and predictive factors in recurrent and/or metastatic head and neck squamous cell carcinoma: a review of the literature. Crit Rev Oncol Hematol 2019;137:84–91CrossRefGoogle ScholarPubMed
Taguchi, T, Nishimura, G, Takahashi, M, Shiono, O, Komatsu, M, Sano, D et al. Treatment results and prognostic factors for advanced squamous cell carcinoma of the head and neck treated with salvage surgery after concurrent chemoradiotherapy. Int J Clin Oncol 2016;21:869–74CrossRefGoogle ScholarPubMed
Perdoni, CJ, Santarelli, GD, Koo, EY, Karakla, DW, Bak, MJ. Clinical and functional outcomes after total laryngectomy and laryngopharyngectomy: analysis by tumor subsite, salvage status, and extent of resection. Head Neck 2019;41:3133–43CrossRefGoogle ScholarPubMed
de Casso, C, Slevin, NJ, Homer, JJ. The impact of radiotherapy on swallowing and speech in patients who undergo total laryngectomy. Otolaryngol Head Neck Surg 2008;139:792–7CrossRefGoogle ScholarPubMed
Clarke, P, Radford, K, Coffey, M, Stewart, M. Speech and swallow rehabilitation in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016;130:S176–80CrossRefGoogle ScholarPubMed