Oncological outcome after free jejunal Xap reconstruction for carcinoma of the hypopharynx

Abstract

It has been a common practice among the oncologist to reduce the dosage of adjuvant radiotherapy for patients after free jejunal Xap reconstruction. The current aims to study potential risk of radiation to the visceral Xap and the subsequent oncological outcome. Between 1996 and 2010, consecutive patients with carcinoma of the hypopharynx requiring laryngectomy, circumferential pharyngectomy and post-operative irradiation were recruited. Ninety-six patients were recruited. TNM tumor staging at presentation was: stage II (40.6%), stage III (34.4%) and stage IV (25.0%). Median follow-up period after surgery was 68 months. After tumor ablation, reconstruction was performed using free jejunal Xap (60.4%), pectoralis major myocutaneous (PM) Xap (31.3%) and free anterolateral thigh (ALT) Xap (8.3%). All patients underwent adjuvant radiotherapy within 6.4 weeks after surgery. The mean total dose of radiation given to those receiving cutaneous and jejunal Xap reconstruction was 62.2 Gy and 54.8 Gy, respectively. There was no secondary ischaemia or necrosis of the Xaps after radiotherapy. The 5-year actuarial loco-regional tumor control for the cutaneous Xap and jejunal Xap group was: stage II (61 vs. 69%, p = 0.9), stage III (36 vs. 46%, p = 0.2) and stage IV (32 vs. 14%, p = 0.04), respectively. Reduction of radiation dosage in free jejunal group adversely aVects the oncological control in stage IV hypopharyngeal carcinoma. In such circumstances, tubed cutaneous Xaps are the preferred reconstructive option, so that full-dose radiotherapy can be given. © Springer-Verlag 2011.