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Tubed Gastro-omental Free Flap for Pharyngoesophageal Reconstruction
Eric M. Genden, MD;
Matthew R. Kaufman, MD;
Brian Katz, MD;
Anthony Vine, MD;
Mark L. Urken, MD
Arch Otolaryngol Head Neck Surg. 2001;127:847-853.
Background Malignant lesions of the pharyngoesophagus often require total laryngopharyngectomy
and mediastinal dissection. As a result of the current treatment paradigms
for advanced laryngopharyngeal cancers, it is common that the surgical field
has been previously irradiated or exposed to systemic chemotherapy, resulting
in fistula rates as high as 78% and mortality as high as 8%. The free vascularized
tubed gastric antrum and the accompanying greater omentum offer a single-staged
method of pharyngoesophageal reconstruction, with the added benefit of protection
of the great vessels, the tracheal stump, and the mediastinal contents in
a high-risk surgical field.
Objective To assess the gastro-omental free flap as a method of pharyngoesophageal
reconstruction in patients who have been previously treated with multimodality
therapy.
Methods Five consecutive cases of gastro-omental free flap reconstruction after
total laryngopharyngectomy were retrospectively reviewed. Each case was assessed
for intraoperative, perioperative, and postoperative complications at the
primary site of reconstruction and the donor site. Patients were also evaluated
for their ability to maintain an oral diet. Patients were followed up for
a minimum of 6 months after surgery.
Results Five patients aged 44 to 70 years (mean, 59 years) underwent gastro-omental
free flap reconstruction after total laryngopharyngectomy. Five patients had
received previous external beam irradiation, 2 had received systemic chemotherapy,
and 4 had undergone previous surgery. There were no fistulae or flap complications.
Three patients were successfully treated with esophageal dilation for strictures
sustained 2 to 5 months after surgery, and a third patient was successfully
treated with conservative management for a partial gastric outlet obstruction
sustained 2 months after surgery. One patient died 3 months after surgery
of distant metastatic disease. The remaining 4 patients currently tolerate
an oral diet.
Conclusion The tubed gastro-omental free flap offers a safe method of reconstructing
the pharyngoesophageal segment in a surgical field compromised by previous
multimodality therapy.
From the Departments of Otolaryngology–Head and Neck Surgery
(Drs Genden, Kaufman, and Urken) and Surgery (Drs Katz and Vine), Mount Sinai
School of Medicine, New York, NY.
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