Reconstruction after hypopharyngeal cancer surgery: comparison of outcomes in pectoralis major, radial forearm, and jejunal flap

Reconstruction following hypopharyngolaryngectomy remains a challenge for head and neck surgeons. Several techniques have been described. There is no consensus on the primary preference for hypopharyngeal reconstruction. We compared clinical and on- cological outcomes between three different types of reconstruction. We identified patients who had undergone reconstruction of the pharyngeal defect using radial forearm flap (RFF) pectoralis major myocutaneous flap (PMMF) or jejunal free flap (JFF). We revised site and stage of the tumor, postoperative complications, surgical margins, morbidity, recurrence, survival and mortality. Resumption of feeding and hospital stay were also recorded. Primary recon- struction (n = 153) was obtained by JFF in 67 patients (43.8 %) PMMF in 47 cases (30.7 %) and RFF in 39 (25.5 %). Flap necro- sis was significantly less frequent in PMMF than in the other flap types (p:0.002). PMMF treated patients were significantly more frequently 65-years or older than JFF and RFF ones (p:0.011 and 0.04). There was no difference in the rate of minor complications in the three groups. Overall survival (OS) was significantly shorter in PMMF than in JFF and RFF (p: 0.008 and 0.035 respectively). Pa- rameters associated with shorter OS were PMMF surgery (p:0.0071) pT4 (p:0.0315) positive surgical margins (p:0.0028) neck metastasis (p:0.0376) ENE (p:0.0054) and a history of previous squamous cell carcinoma (p:0.0130). In our experience JFF patients had a lower rate of complications requiring repair surgery and a shorter hospi- tal stay and feeding tube weaning than RFF. We observed a signif- icantly higher rate of major complications requiring surgical repair in RFF than in the other flap types.