Impact of the method and success of pharyngeal reconstruction on the outcome of treating laryngeal and hypopharyngeal cancers with pharyngolaryngectomy: a national analysis

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 70; no. 5; pp. 628 - 638
• Main Authors: Nouraei, S.A.R, Dias, A, Kanona, H, Vokes, D, O'Flynn, P, Clarke, P.M, Middleton, S.E, Darzi, A, Aylin, P, Jallali, N
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.05.2017
• Subjects: Age Distribution; England - epidemiology; Female; Gastric pull-up; Health informatics; Humans; Hypopharyngeal cancer; Hypopharyngeal Neoplasms - epidemiology; Hypopharyngeal Neoplasms - surgery; Laryngeal Neoplasms - epidemiology; Laryngeal Neoplasms - surgery; Laryngectomy - methods; Laryngectomy - statistics & numerical data; Male; Middle Aged; Pharyngectomy - methods; Pharyngectomy - statistics & numerical data; Pharyngolaryngectomy; Plastic Surgery; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Surgical Flaps; Treatment Outcome; Wound Closure Techniques - statistics & numerical data; Pharyngolaryngectomy; Hypopharyngeal cancer; Health Informatics; Gastric pull-up; Health informatics
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2016.12.009

Abstract Background Surgical treatment of cancers which arise from or invade the hypopharynx presents major reconstructive challenges. Reconstructive failure exposes the airway and neck vessels to digestive contents. Methods We performed a national N=near-all analysis of the administrative dataset to identify pharyngolaryngectomies in England between 2002 and 2012. Information about morbidity, pharyngeal closure method, and postoperative complications were derived. Results There were 1589 predominantly male (78%) patients whose mean age at surgery was 62 years. The commonest morbidities were hypertension (24%) and ischemic heart disease (11%). For 232 (15%) of patients, pharyngolaryngectomy was performed during an emergency admission. The pharynx was primarily in 551 patients, with skin or muscle free or pedicled flaps in 755 patients, and with jejunum and gastric pull-up in 123 and 160 patients respectively. In-hospital mortality rate was 6% and was significantly higher in the gastric pull-up group (11%). Reconstructive failure had an odds ratio of 6.2 [95% confidence interval (CI) 2.4-16.1] for in-hospital death. Five-year survival was 57% and age, morbidities, emergency surgery, gastric pull-up, major acute cardiovascular events, renal failure, and reconstructive failure independently worsened prognosis. Patients who had pharyngeal reconstruction using radial forearm or anterolateral thigh flaps had lower mortality rates compared to patients who had jejunum flap reconstruction (Hazard Ratio = 1.50 [95% CI 1.03-2.19]) or gastric pull-up (Hazard Ratio = 1.92 [95% CI 1.32-2.80]). Conclusions Pharyngolaryngectomy carries a high degree of morbidity and mortality. Reconstructive failure worsens short- and long-term prognosis, and use of cutaneous free flaps appears to improve survival.