Laryngopharyngectomy may form a leftover narrow strip of the posterior pharyngeal
wall, and whether to retain it during reconstruction remains debated owing to the
differing views on the incidence of leakage and strictures. The study aimed to ascertain
whether this remnant posterior pharyngeal wall is advantageous or disadvantageous to
surgeons during pharyngoesophageal reconstruction.
We reviewed the data of patients with circumferential or near-circumferential
pharyngoesophageal defects following oncological laryngopharyngectomy who
underwent reconstructive surgery utilizing the anterolateral thigh flap. They were then
categorized into two groups: circumferential and near-circumferential. Thereafter, their
demographics, operative findings, and postoperative outcomes were compared.
Forty patients (20 in each group) with an average age of 57.2±6.7 years (range: 40-72)
were enrolled in the study. All flaps except one survived. During a mean follow-up of
41.1±24.6 (range: 6-95) months, the stricture rate was significantly lower in the near-
circumferential group (one vs. nine (from 17 patients who had resumed oral intake
postoperatively) patients in the near-circumferential and circumferential groups,
respectively, p=0.002). Oral intake was viable in all patients with near-circumferential
defects but only in 11 patients with circumferential defects (p=0.003).
The near-circumferential group had fewer strictures and better tolerance of oral
nutrition, supporting the incorporation of the residual posterior pharyngeal wall via
near-circumferential reconstruction instead of discarding it to facilitate circumferential
reconstruction.