Hypopharyngeal reconstruction with an anterolateral thigh flap after laryngopharyngeal resection: results of a retrospective study on 20 patients.

Abstract

The aim of this retrospective study is to evaluate short- and long-term postoperative morbidity and mortality of hypopharyngeal resection and reconstruction. Patients with laryngopharyngeal malignancies were treated with laryngopharyngectomy and the resulting defect was reconstructed with an anterolateral thigh flap. The study group consisted of 20 patients with one or more primary hypopharyngeal carcinomas or a relapse of this tumour. All patients were diagnosed and operated in the University Medical Center between February 2000 and July 2007. Data were collected from the clinical medical files of the departments of plastic surgery and oto-rhino-laryngology. The dietetic and speech therapy files were used as well. To study the quality of life, the Dutch version of the University of Washington Quality of Life questionnaire was sent to all surviving patients. The microsurgical reconstructions were 100% successful. Fifteen patients (75.0%) died during the follow-up period; the 5-year overall survival was 20%. Complications such as post-surgical fistulas and strictures requiring surgical intervention were found in five (25.0%) and six patients (30.0%), respectively. Other post-surgical complications such as wound dehiscence were seen in two patients (10.0%). The incidence of donor-site complications at the thigh was very low. No significant relationship was found among preoperative patients' characteristics like age, gender, preoperative radiotherapy, the TNM (tumour, node, metastasis) classification of the tumour and the risk of post-surgical complications. The number and/or the severity of the complications were not significantly associated with the duration of surgery or ischaemia time. In our view, surgery is a good option in the treatment of these patients. Although curative treatment is the best outcome, a satisfactory palliation in itself can be a justification for this type of surgery. Although only seven patients were able to answer the QOL questionnaire, the positive judgements of these patients support this view point.