Advanced Carcinoma of the Hypopharynx: Functional Results after Circumferential Pharyngolaryngectomy with Flap Reconstruction

摘要

Surgical treatment of advanced cancers of the hypopharynx inevitably impairs swallowing, respiration and phonation. The purpose of thisstudy was to analyze the functional results after circumferential pharyngolaryngectomy (CPL) and flap reconstruction, in order to offerdecisional guidelines for the choice of the most effective reconstructive method. We performed a retrospective analysis on the medicalrecords of patients submitted to reconstructive surgery after CPL from July 1991 to November 2011. 75% of the 94 patients underwentreconstruction with a free flap (group A), while 25% underwent reconstruction with a pedicled flap (group B); 80% of patients in group Aand none in group B were discharged with a free diet; 14% of patients in group A and 26% in group B were unable to resume oral feedingand were discharged with NG-tube or PEG. None of the patients acquired a satisfactory oesophageal voice; 17% of patients in group A and7% in group B underwent voice restoration with tracheo-oesophageal voice-prosthesis. In conclusion, free flaps should be considered thefirst choice for reconstruction of the hypopharynx after CPL because of the better functional results obtained. Pedicled flaps represent avalid alternative in patients with contraindications to microvascular surgery