Hypopharyngeal Reconstruction: Retrospective study of reconstruction of the pharynx with comparison of three alternatives

Abstract

The hypopharynx is the last part of pharynx that connects the oropharynx above to the esophaguses below. It's responsible for moving the food bolus by a series of coordinated muscular contractions, while distension and vibration of the pharyngeal wall are responsible for phonation. Hypopharyngeal squamous cell carcinoma (HSCC) accounts for about 5% of all head and neck cancers and includes primary hypopharyngeal tumors and advanced tumors originating from other sites, in particular, the larynx. The majority of these cancers present with large bulky neck nodes, distant metastasis, and extensive sub- mucosal disease. The available therapeutic options are surgery followed by adjuvant treatment or organ preservation in the form of chemoradiation therapy. Although primary treat- ment of hypopharyngeal cancer is increasingly relying on nonsurgical modalities, for selected advanced stages and for patients in whom nonsurgical treatment fails, surgery remains the only curative option. Surgical treatment of advanced hypopharyngeal cancer remains a challenge for surgeons due to the di culty of restoring digestive continuity, considering the dis- tance covered, and the maintenance and provision of adequate blood supply to the reconstructive grafts. The reconstructive approach depends on the amount of pharyngeal resection re- quired. In some patients, the pharyngeal wound can be primarily closed, but cases with extensive partial or circumferential pharyngeal resection require reconstruction to close the defect. Several techniques have been developed and applied to the reconstruction of hy- popharyngeal defects, including cervical aps, tubed cutaneous and myocutaneous chest aps, gastric pull-up, and free jejunal autografts. The ideal reconstructive technique for such defects, possibly involving the cervical esophagus, should o er the patient a prompt, acceptable functional recovery with the lowest morbidity and mortality and fair quality for their remaining life. Pharyngeal reconstruction with a free jejunal graft has rapidly evolved to become a choice among these procedures and has been widely used to achieve relatively lower mortality and morbidity; the reported success rates for the procedure reach 95{100%. Its popularity is due to anatomical and physiological advantages: the transposed short intestinal tract is anatomically well adapted to the reconstruction site, provides low stula and stricture rates, and ensures rapid recovery to permit adjuvant radiotherapy and good functional recovery. The rst few chapters of this dissertation will try to lay a well-rounded overview of pharynx and larynx anatomy and physiology. I will then review the existing modalities of reconstruction and survey the advantages, disadvantages. The last chapters, on the other hand, will build upon the patient's records that were reviewed to determine the indications for radical resection, location, and stage of the primary tumor, postoperative complications, morbidity, mortality, tumor re- currence, and survival. proceed to employ a retrospective model study of the pa- tients treated in our Otorhinolaryngology department at the Policlinico S. Matteo di Pavia. 7