Tubed Gastro-omental Free Flap for Pharyngoesophageal Reconstruction
Background: Malignant lesions of the pharyngoesopha- gus often require total laryngopharyngectomy and me- diastinal dissection. As a result of the current treatment paradigms for advanced laryngopharyngeal cancers, it is common that the surgical field has been previously ir- radiated or exposed to systemic chemotherapy, result- ing in fistula rates as high as 78% and mortality as high as 8%. The free vascularized tubed gastric antrum and the accompanying greater omentum offer a single- staged method of pharyngoesophageal reconstruction, with the added benefit of protection of the great vessels, the tracheal stump, and the mediastinal contents in a high- risk surgical field. Objective: To assess the gastro-omental free flap as a method of pharyngoesophageal reconstruction in pa- tients who have been previously treated with multimo- dality therapy. Methods: Five consecutive cases of gastro-omental free flap reconstruction after total laryngopharyngectomy were retrospectively reviewed. Each case was assessed for in- traoperative, perioperative, and postoperative complica- tions at the primary site of reconstruction and the do- nor site. Patients were also evaluated for their ability to maintain an oral diet. Patients were followed up for a mini- mum of 6 months after surgery. Results: Five patients aged 44 to 70 years (mean, 59 years) underwent gastro-omental free flap reconstruction after total laryngopharyngectomy. Five patients had received previous external beam irradiation, 2 had received sys- temic chemotherapy, and 4 had undergone previous sur- gery. There were no fistulae or flap complications. Three patients were successfully treated with esophageal dila- tion for strictures sustained 2 to 5 months after surgery, and a third patient was successfully treated with conser- vative management for a partial gastric outlet obstruction sustained 2 months after surgery. One patient died 3 months after surgery of distant metastatic disease. The re- maining 4 patients currently tolerate an oral diet. Conclusion: The tubed gastro-omental free flap offers a safe method of reconstructing the pharyngoesopha- geal segment in a surgical field compromised by previ- ous multimodality therapy. Arch Otolaryngol Head Neck Surg. 2001;127:847-853
Published in 2001.