Outcomes of Gastro-omental Free Flap Reconstruction for Salvage Laryngopharyngectomy for Pharyngeal and Laryngeal Cancer After Concurrent Chemoradiotherapy.

ABSTRACT

BACKGROUND: In the case of salvage laryngopharyngectomy, replacement of the pharyngoesophageal segment is mostly performed with fasciocutaneous or jejunal flaps. However, these options do not represent the best surgical technique of reconstruction in some occasions. Thus, the gastro-omental free flap could serve as an alternative procedure. METHODS: A retrospective review was conducted on patients who underwent pharyngoesophageal reconstruction using gastro-omental free flap after salvage laryngopharyngectomy for recurrent pharyngeal or laryngeal carcinoma between 1992 and 2012 at Bellvitge Universitary Hospital. The perioperative morbidity, mortality, functional outcomes, and oncological outcomes were evaluated. RESULTS: Twenty-six patients were included and followed up at our hospital for a mean of 43.4 months (range, 12-184 months). Survival rate was 94% after 1-year follow-up and 89% after 3 years. Abdominal evisceration was observed in 2 cases, whereas no abdominal complications occurred to the other patients. Total flap necrosis was observed in 3 (11.5%) patients. Postoperative course was uneventful in 20 patients. Moreover, esophageal continuity without fistula was confirmed by barium swallow test. CONCLUSIONS: The gastro-omental flap represents a useful method for reconstruction of the pharyngoesophageal segment in a surgical field compromised by previous multimodal therapy. Despite being useful, the complication rate is relevant.