[Revascularized jejunum loop in hypopharyngeal reconstruction: oncological and functional results]

The aggressiveness of hypopharyngeal cancer makes broad resectioning of the
circular pharyngolaryngoesophageal segments necessary, followed by reconstruction
to restore the anatomical gap created as fully as possibly creating a
neoesophagus with thin walls that can easily be released. Over the years several
procedures have been fine tuned for reconstruction of the upper digestive tract
employing transposed viscera, miocutaneous pedunculated flaps, revascularized
fascio-cutaneous or visceral free flaps. Currently the revascularized jejunum
loop is one of the most commonly used methods in the reconstruction of the
hypopharynx. Its popularity is due to some anatomical and physiological
advantages: it requires transposition of a brief intestinal tract anatomically
well adapted to the reconstruction site, ensuring rapid functional recovery. The
authors report the oncological and functional results obtained in 25 patients who
underwent circular pharyngolaryngectomy followed by reconstruction with a
revascularized jejunum loop. The percentage of transplant survival was 90% and
local and general complications were reduced to a minimum. The functional
results--both in terms of deglutition and phonation--were satisfactory while
patient survival (6-37 months follow-up) was in line with that reported by other
authors for the same tumor (47%). Although prognosis for
hypopharyngeal-esophageal neoplasms is still quite poor, this experience shows
that circular pharyngolaryngectomy followed by reconstruction with autotransplant
of the jejunum is an excellent choice since it offers the patient a prompt,
acceptable functional recovery and a fair quality for his remaining life.