Ten-Year Experience of Reconstructive Techniques After Resection of Hypopharyngeal Squamous Cell Carcinoma (SCC): Changing Trend from Gastric Pull up to Free Flaps

Abstract

Background: Hypo-pharyngeal squamous cell carcinoma (H-SCC) is a rare type of head and neck malignancy often necessitating extensive surgical resection and subsequent reconstruction. Objectives: This study presented a 10-year retrospective analysis of reconstructive surgeries following the resection of H-SCC. Methods: A cross-sectional study was conducted on H-SCC patients who underwent reconstructive surgery after either laryngopharyngoesophagectomy (13 cases, 42%) or pharyngolaryngectomy (18 cases, 58%). Various reconstructive techniques were employed, including gastric pull up (12 cases, 39%), pectoralis major myo-cutaneous flap (PMMCF) (11 cases, 35%), and free flaps such as jejunum (2 cases, 6%), ileocecal (2 cases, 6%), or antero-lateral thigh (ALT) (4 cases, 13%). Results: The study included 31 patients with a mean age of 56.26 ± 3.98 years, predominantly male (64%). Smoking habit was observed in 22 (71%) patients. The total complication rate was 48% including 2 (6%) cases of flap loss, 2 (6%) cases of cervical anastomosis leak, 1 (3%) case of hematoma, 2 (6%) cases of neck wound infection, 5 (16%) cases of pneumonia, and 3 (10%) cases of pleural effusion, with a mortality rate of 16%. GPU and PMMCF had total number of post operative complications of 12 and 6, respectively. ALT flap, jejunal flap and ileocecal flap had 3, 2 and 1 total complications, respectively. Severe stenosis at cervical anastomosis was found in 4 (13%) patients after GPU and not other techniques. Conclusions: Advances in microvascular anatomy knowledge have led to the evolution of reconstructive techniques. The study suggests that in upcoming years, the free flap techniques hold promise as a preferred method for hypo-pharyngeal reconstruction.