Efficacy and Safety of Microsurgical Pharyngolaryngeal and Pharyngoesophageal Reconstruction: A Systematic Review of the Literature

Abstract

Background: Restoration of function and complication management after pharyngolaryngectomy remains a challenging task. The aim of our study was to compare the functional and clinical outcomes of pharyngolaryngeal and pharyngoesophageal reconstruction using free flaps, namely jejunal (FJF), anterolateral thigh, and radial forearm, and describe a reconstructive approach for these defects following tumor resection. Methods: We performed a systematic literature review on PubMed (Medline), Embase and Cochrane Library over the last two decades for articles reporting the surgical reconstructive modalities available after total or partial pharyngeal and/or laryngeal resection using a structured search strategy and strict inclusion and elimination criteria. Results: Our search identified a total of 677 articles, 112 full texts were fully reviewed for eligibility, and 39 met the inclusion criteria. The use of both FJF and fasciocutaneous flaps is safe. The FJF has optimal swallowing outcomes and a low incidence of major recipient-site complications. Nevertheless, free fasciocutaneous flaps exhibit comparable functional results, while they seem linked with fewer cases of perioperative mortality and flap failure. However, none of the currently available techniques can combine all potential benefits. Conclusions: Despite these procedures being mainly palliative in nature, the advent of microvascular techniques and utilization of fasciocutaneous free flaps has allowed optimal restoration of function combined with a reduced rate of perioperative and longterm complications. Both FJF and fasciocutaneous flaps can be viable treatment options, depending on the expertise of the surgeon and patient selection, to ensure the best outcomes.

Reconstruction for Salvage Laryngectomy With Limited Pharyngectomy

“…These findings are more relevant in the context of the potential selection bias, as patients in the FTT group had higher rates of chemotherapy, neck dissection, and pharyngectomy, all of which have been previously associated with an increased risk of PCF. [20][21][22] Other studies have shown the benefits of FTT in the context of salvage laryngectomy, including an association with reduction in PCF rates 22,23 or with a decreased duration of PCF. 11 A multicenter study of patients undergoing operations between 2002 and 2010 showed that FTT was used in 33% of the 379 patients in the total laryngectomy or partial pharyngectomy group, with only 34 patients undergoing cutaneous pharyngeal inset in the pure laryngectomy group.…”