Functional Outcome Following Colon Interposition in Total Pharyngoesophagectomy with or without Laryngectomy

Abstract

Our study compares deglutition between a group who had undergone total esophagopharyngolaryngectomy and a group who had esophagectomy and partial pharyngectomy with preserved larynx, after reconstruction of the upper digestive tract with pedicled colon interposition. In four patients the laryngeal structures could be preserved (three caustic burns and one proximal esophageal tumor). Six patients underwent a total laryngopharyngectomy for large pharyngeal tumors. Swallowing was assessed by a questionnaire, clinical examination, and videofluoroscopy. All patients had normal intake of semisolid foods and fluids. All patients but three experienced some feeling of "narrowing" of the tract: four at the level of the hypopharynx, two at the oropharyngeal level, one at the oral level. In the laryngectomy group, solid food caused some degree of delayed swallowing in three patients. Dumping occurred in one case out of the nonlaryngectomy group. On clinical examination a tense motility in all laryngectomy patients appeared, food remnants in five and repeated swallowing movements in four. The videofluoroscopy confirmed repeated swallowing movements and presence of residual food in the oral cavity. Temporal stagnation occurred at the anastomosis site in all patients and in two patients at a place of colon redundancy. Colon interposition is a reliable reconstruction and gives the possibility of a good functional outcome. Although preservation of the larynx facilitates swallowing even in this reconstructive procedure, it may be better to perform a total laryngopharyngectomy and colon interposition in oncological cases where the pharyngeal remnant is borderline for primary closure.

Functional outcome following free ileocolic flap in total pharyngolaryngectomy

“…In our study, the free ileocolic flap was found to give excellent results in comparison with other methods. Physiologically, the larger diameter and greater length of a colon graft make it a good choice for restoration of swallowing function at the level of the hypopharynx and the shorter length of jejunum makes sound easily by vibration as a higher pitched tone [4,5]. In our study, all patients except two could initially swallow a semi-solid or solid diet without aspiration (13/15 086.67%).…”

“…Free intestinal flap was recognized as impaired swallowing outcome due to considerable amount of residue in the conduit after swallowing [4]. Moerman et al [5] suggested that colon interposition is a reliable reconstruction procedure. The ileocolic flap was designated as small intestine as voice shunt tube and colon as feeding continuity.…”

“…After a total laryngopharyngectomy, there is a disadvantage of unnecessary resection of the intact distal esophagus [1] for the purpose of restoration of upper digestive tract by a free jejunal graft, a gastric pullup or a myocutaneous flap [5]. Free jejunal grafts are a reliable alternative but demand a microvascular anastomosis [5].…”

“…Free jejunal grafts are a reliable alternative but demand a microvascular anastomosis [5]. As peristalsis is diminished or absent in the colon graft, food is mainly transported by gravity and propulsion forces of the tongue base in repeated swallowing maneuvers [5].…”

“…The propulsion force of the base of the tongue against the open reconstructive tract is the important factor for guaranteeing successful swallowing [5]. Voice rehabilitation after total pharyngolaryngectomy consists of esophageal speech, an external artificial larynx device or an intrinsic shunt connecting the respiratory tract to the upper digestive tract (TE shunt).…”