Pharyngoesophageal reconstruction with the gastric pull-up: Functional outcomes in a cohort of 49 patients

Reconstruction of cervical esophagus for hypopharyngeal or thyroid cancer with intractable leakage at the upper end of thoracic esophagus: A scoping review and the pedicled colon flap solution

INTRODUCTION

Patients with advanced hypopharyngeal cancers or thyroid cancers often require pharyngoesophageal reconstruction after tumor ablation, but complications are frequent. Anastomotic leakage, particularly in patients receiving perioperative radiation therapy, poses a significant challenge. The aim of this study was to conduct a literature review on leakage management methods and present a novel approach: utilizing a pedicled colon flap to create a diverted conduit connected to the cervical neo-esophagus.

PATIENTS AND METHODS

A scoping review was conducted in March 2024. Additionally, between 2004 and 2022, 17 patients underwent pedicled colon transposition to the newly reconstructed cervical neo-esophagus. Four had neoadjuvant radiation therapy for thyroid or hypopharyngeal cancer, and the pedicled colon transposition method was used to prevent anastomotic leakage after hypopharyngeal reconstruction. The other 13 suffered leakage at the junction of the cervical neo-esophagus and thoracic esophagus after reconstruction. The method involved closing the cephalic end of the thoracic esophagus and using the pedicled colon transposition to restore alimentary tract continuity.

RESULTS

The review identified 4 leakage prevention methods. In our clinical series, colon flap harvest averaged 4.5 h with no postoperative leakage observed. All patients resumed oral intake, but 65% experienced transient diarrhea that resolved within a month.

CONCLUSION

For patients who receive perioperative irradiation that complicates pharyngoesophageal reconstructions, a supercharged pedicled colon flap presents a feasible solution for managing anastomotic leakage.

Prospective cohort study of voice outcomes following secondary tracheoesophageal puncture in gastric pull-up reconstruction after total laryngopharyngoesophagectomy

Background

Gastric pull-up is a reconstructive option for circumferential defects after resection of advanced laryngopharyngeal malignancy. Voice loss is expected and vocal rehabilitation remains a challenge. Our study objectives were to investigate the feasibility of secondary tracheoesophageal puncture following gastric pull-up and to analyze voice outcomes.

Methods

This was a prospective cohort study of patients with advanced laryngopharyngeal malignancies who underwent gastric pull-up and secondary tracheoesophageal puncture between 1988 and 2017 at a tertiary-care academic institution. Objective acoustic measures included fundamental frequency and vocal intensity. Perceptual analysis was performed using voice recordings (“Rainbow Passage”) randomly presented in a blinded fashion to four clinicians using the validated GRBAS scale. Speech intelligibility was assessed in a blinded fashion using a validated 7-point scale. Additionally, the Voice Handicap Index-10 was administered as a validated patient self-reporting tool.

Results

Ten patients (7 male, 3 female) were included, all of whom preferentially used tracheoesophageal puncture for communication. These patients had abnormal median fundamental frequency of 250 (interquartile range (IQR) 214–265) Hz and a limited median vocal intensity of 65.8 (IQR 64.1–68.3) dB. Perceptual analysis (GRBAS) revealed a median ‘moderate’ degree of impairment [grade 2 (IQR 2–3), roughness 2 (IQR 2–3), breathiness 3 (IQR 2–3), asthenia 2 (IQR 1–2), strain 2 (IQR 1–2)] as did median intelligibility scores [median 5 (IQR 4–7)]. Most patients self-reported an abnormal voice handicap-10 [median 26.5 (IQR 22.8–35.0)].

Conclusion

Secondary tracheoesophageal puncture is a safe and feasible option for voice rehabilitation after gastric pull-up. Although analyses demonstrated moderate subjective and objective impairment, tracheoesophageal puncture provided patients with a self-reported means of functional verbal communication and was their preferred method of communication.

Graphical abstract