Significance of Laryngo-tracheal flap to reconstruct the defect and management of pharyngoesophageal stenosis after resection of the hypopharyngeal carcinoma with cervical esophagus involvement

Abstract There are many ways to solve hypopharyngeal defection, such as use pectoralis major, clavicle epithelial flap, or free flap repair (e. g. forearm free flap), gastric pull-up and so on to reconstruct cervical esophagus. In the study, we investigate cervical esophageal reconstruction by means of laryngo-tracheal flap and the management of postoperative pharyngoesophageal stenosis after resection of hypopharyngeal carcinoma with cervical esophageal involvement. All 14 cases had good swallowing reflex, fed on normal diet free of feeding tube and no gastric reflux. With a follow-up of 3-10 years, there was no recurrence in 9 patients, 3 patients had metastases in the neck, 1 patient had metastases in the lung and 1 patient had thoracic esophageal carcinoma with hepatic metastasis arid gave up further treatment. Among the 14 patients, one patient developed pharyngocutaneous fistula, and the remaining patients recovered well. Two patients with pharyngoesophageal stenosis causing feeding difficulties were given nasogastric tube nasal feeding and urinary catheter dilation after scar tissue was removed by coblator plasma surgery at the stenosis and were fed to the nasogastric tube for 1-3 months. Accordingly, using laryngo-tracheal flap to reconstruct cervical esophagus after resection of hypopharyngeal carcinoma with cervical esophageal involvement is a recommendable method that is simple, convenient, with high success rate and low complications (complications are mainly pharyngocutaneous fistula and pharyngoesophageal stenosis), which can be effectively used for the repair of postoperative defects of hypopharyngeal cancer. The disadvantage is that the throat is sacrificed and insufficient for the large defect tissue. Coblator plasma surgery and urinary catheter dilation can effectively handle the problem of eating difficulties in patients with postoperative pharyngoesophageal stenosis.