[Reconstruction of hypopharyngeal circumferential defects: pharyngogastric anastomosis or free jejunal interposition].

OBJECTIVE: To choose the optimal reconstruction for circumferential defects of the hypopharynx between pharyngogastric anastomosis and free jejunal interposition is.
METHODS: Retrospective review of the archives of 125 patients who underwent pharyngoesophageal reconstruction with pharyngogastric anastomosis(n = 92) or free jejunal interposition(n = 33). Analysis was confined to patient with advanced hypopharyngeal cancer or recurrent laryngeal cancer who had hypopharyngeal circumferential defects after tumor ablation.
RESULTS: The morbidity and mortality associated with reconstructive procedures were significantly higher in the pharyngogastric anastomosis group than in the free jejunal interposition group (43% versus 21%, P = 0.023 and 11% versus 0%, P = 0. 048). The risk factors related to complications associated with the procedures were reconstruction with pharyngogastric anastomosis (OR 2.97; 95% CI 1.14; 7.76) and albumin < 40.0 g/L(OR 2.87; 95% CI 1.33; 6.16) . The occurrence of swallow obstruction or regurgitation was higher in the pharyngogastric anastomosis group than in the free jejunal interposition group(76% versus 12%, P = 0.00). Patients in the pharyngogastric anastomosis group had lost weight of 3.3 kg (95% CI - 5.7; - 1.0) postoperatively, on the contrary, patients in the free jejunal interposition group had gained weight of 2.8 kg(95% CI 0.9; 4.7) postoperatively.
CONCLUSION: Patients reconstructed with free jejunal interposition had lower mortality and complications than with pharyngogastric anastomosis. Furthermore, the former seems to have better quality of life than the latter. The first choice of reconstructive strategy for hypopharyngeal circumferential defects is free jejunal interposition.