Esophageal reconstruction after oncological total laryngopharyngoesophagectomy: Algorithmic approach.
Microsurgery
; 39(1): 6-13, 2019 Jan.
Article
en En
| MEDLINE
| ID: mdl-29400418
ABSTRACT
BACKGROUND:
Reconstruction for total laryngopharyngoesophagectomy is accomplished mainly by gastrointestinal transposition but can be complicated by anastomotic tension or associated neck-skin defect. Here, we present the results of total esophageal reconstruction by gastrointestinal transposition alone or with additional free tissue transfer and propose an algorithm accordingly.METHODS:
We reviewed patients who had oncologic total laryngopharyngoesophagectomy between January 2012 and January 2016. Twenty-four men and one woman were included with a mean age of 54 (range, 41-72) years. Patients were grouped by reconstruction into the gastric pull-up (GP, n = 15), colon interposition (CI, n = 2), GP combined with free jejunal flap (GPFJ, n = 6), or GP combined with anterolateral thigh flap (GPALT, n = 2) group to compare clinical outcomes.RESULTS:
The mean operation time was 1037.3 minutes and was significantly longer in the GPALT group than in the GP group (1235.0 ± 50.0 minutes vs. 929.7 ± 137.7 minutes, p =.009). All flaps survived. After a mean follow-up of 18 months, the overall leakage, stricture, and successful swallowing rates were 44%, 4%, and 76%, respectively. There was no significant difference in the leakage (53.3%, 50.0%, 16.7%, and 50.0%, p =.581), stricture (6.7%, 0%, 0%, and 0%, p = 1.000), or successful swallowing (73.3%, 50.0%, 83.3%, and 100%, p =.783) rates between GP, CI, GPFJ, and GPALT groups, respectively.CONCLUSIONS:
The proposed algorithm that ranks gastric pull-up as a priority and uses additional free tissue transfer to overcome the anastomotic tension or associated neck-skin defect is feasible.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Faringectomía
/
Esofagectomía
/
Procedimientos de Cirugía Plástica
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Esofagoplastia
/
Neoplasias de Cabeza y Cuello
/
Laringectomía
Tipo de estudio:
Observational_studies
Límite:
Adult
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Aged
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Microsurgery
Año:
2019
Tipo del documento:
Article
País de afiliación:
Taiwán