A reconstruction strategy for various types of resection of hypopharyngeal/cervical esophageal cancer

Since hypopharyneal/cervical esophageal cancer is often associated with other cancers in the upper gastrointestinal tract, there are cases in which total esophagectomy combined with total pharyngolaryngoesophagectomy (TPLE) is necessary. On the other hand, with recent advances in chemoradiotherapy, the number of cases of hypopharyngeal cancer which can be treated with partial pharyngectomy instead of TPLE is increasing. Because the conventional reconstruction strategy cannot be applied to such cases, appropriate reconstruction methods for these defects are required. We reviewed cases of hypopharyngeal/cervical esophageal cancer which were variably resected by other than TPLE and reconstructed with free flap. Five cases of partial pharyngectomy and 5 cases of total esophagectomy combined with TPLE are reviewed. The reconstruction methods were free jejunal patch, free radial forearm flap in partial pharyngectomy cases, and elongated stomach roll with supercharge, free jejunum combined with gastric pull-up in extensive resection cases. Each reconstruction method has advantages and disadvantages. Therefore, it is important to discuss age, sex, prognosis, resection area, preserved vessels and general condition preoperatively with head and neck surgeons and gastrointestinal surgeons when planning appropriate reconstruction methods.