Jejunum free flap in hypopharynx reconstruction

Surgical treatment of hypopharyngeal cancers generally requires a circumferential pharyngolaryngectomy followed by a reconstruction of the removed segment of the upper digestive tract. Historically many techniques have been used in order to achieve a safe and functional reconstruction. Jejunum interposition is generally considered the best reconstructive technique in ideal conditions (1). Methods: This study examines the details of the surgical technique, the complications, and the oncological and functional results in a series of 34 consecutive patients submitted to circumferential pharyngoesophageal resection for advanced hypopharyngeal cancer followed by reconstruction with a free flap of jejunum. Results and discussion: Three of the transplants failed because of venous thrombosis. The overall success rate was 91.2%. There were no general complications and good swallowing function has been preserved in all patients. Moreover, all the patients where a phonatory prosthesis was positioned (12/34) were able to achieve speech following speech rehabilitation and all were satisfied with their own capacity to communicate. The percentage of patient survival was 50.0% which is in accordance with the literature. Conclusion: Although the prognosis of hypopharyngeal tumours (18-40% at 5 years) remains poor, jejunum autografts are being shown to be an excellent choice for the reconstruction of the cervical hypopharyngo-oesophagus offering the patient quick rehabilitation and a reasonable quality of survival.