Significance of Laryngo-tracheal flap to reconstruct the defect and management of pharyngoesophageal stenosis after resection of the hypopharyngeal carcinoma with cervical esophagus involvement

Significance of Laryngo-tracheal flap to reconstruct the defect and management of pharyngoesophageal stenosis after resection of the hypopharyngeal carcinoma with cervical esophagus involvement | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Significance of Laryngo-tracheal flap to reconstruct the defect and management of pharyngoesophageal stenosis after resection of the hypopharyngeal carcinoma with cervical esophagus involvement qian qiyong, wang qinying This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4282382/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract There are many ways to solve hypopharyngeal defection, such as use pectoralis major, clavicle epithelial flap, or free flap repair (e. g. forearm free flap), gastric pull-up and so on to reconstruct cervical esophagus. In the study, we investigate cervical esophageal reconstruction by means of laryngo-tracheal flap and the management of postoperative pharyngoesophageal stenosis after resection of hypopharyngeal carcinoma with cervical esophageal involvement. All 14 cases had good swallowing reflex, fed on normal diet free of feeding tube and no gastric reflux. With a follow-up of 3-10 years, there was no recurrence in 9 patients, 3 patients had metastases in the neck, 1 patient had metastases in the lung and 1 patient had thoracic esophageal carcinoma with hepatic metastasis arid gave up further treatment. Among the 14 patients, one patient developed pharyngocutaneous fistula, and the remaining patients recovered well. Two patients with pharyngoesophageal stenosis causing feeding difficulties were given nasogastric tube nasal feeding and urinary catheter dilation after scar tissue was removed by coblator plasma surgery at the stenosis and were fed to the nasogastric tube for 1-3 months. Accordingly, using laryngo-tracheal flap to reconstruct cervical esophagus after resection of hypopharyngeal carcinoma with cervical esophageal involvement is a recommendable method that is simple, convenient, with high success rate and low complications (complications are mainly pharyngocutaneous fistula and pharyngoesophageal stenosis), which can be effectively used for the repair of postoperative defects of hypopharyngeal cancer. The disadvantage is that the throat is sacrificed and insufficient for the large defect tissue. Coblator plasma surgery and urinary catheter dilation can effectively handle the problem of eating difficulties in patients with postoperative pharyngoesophageal stenosis. hypopharyngeal cancer functional reconstruction surgery Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Squamous cell carcinoma of the hypopharynx (HPSCC) usually presents with an advanced stage and generally has a poor prognosis. The reasons for this poor prognosis are late presentation, submucosal spreading and early lymphatic/distant metastasis [ 1 ]. Surgery with postoperative radiation or chemoradiation therapy has been the standard treatment for HPSCC, although an organ preservation protocol with chemoradiation therapy has become more popular in recent years [ 2 , 3 ]. In a review of the literature, only 15–34% of HPSCC patients are suitable for conservation surgery that is able to preserve laryngeal functioning. Most patients need radical surgery, which includes total laryngectomy, partial or total pharyngectomy and/or esophagectomy. Radical surgery may result in a large surgical defect of thehypopharyngeal and cervical esophageal regions. Therefore, reconstruction of the surgical defect is important in order to restore the continuity of the gastrointestinal tract and allow oral alimentation. There are many ways to solve hypopharyngeal defection, such as use pectoralis major, clavicle epithelial flap, or free flap repair (e. g. forearm free flap), gastric pull-up and so on to reconstruct cervical esophagus [ 4 , 5 , 6 , 7 ]. But ,when the patient needs total laryngectomy, and the laryngeal cavity stent and mucosa are not invaded by the tumor, the larynx and esophagus can be considered༎ For hypopharyngeal cancer involving cervical esophagus(CE) invasion throat, resection under the pharynx and part of the throat, throat abandoned unfortunately, using residual throat repair pharynx and cervical esophageal defect, trachea and esophagus, both to pharyngeal cancer radical resection, and make full use of the residual throat, solve the problem of cervical esophageal material, is pharyngeal cancer involving cervical esophagus combined laryngeal invasion very valuable way of surgery༎ Metheds The participant in this report signed informed consent, participated voluntarily, and had the right to withdraw at any stage. Ethical approval was obtained from The First Affiliated Hospital,College of Medicine, Zhe Jiang University Research Ethics Committee.All procedures were performed in accordance with the principles of Declaration of Helsinki. Clinical samples and data collection The clinical data of 14 patients with postoperative defects of residual laryngeal repair during 2012–2021, and the management strategies of two patients with complicated laryngopharyngeal stenosis were analyzed(Table 1 )༎All 14 patients were male, aged 51 to 80 years and median age 69.5 years༎10 of the 14 patients had a history of smoking and 9 patients had alcohol consumption. The main manifestations are sore throat, pharyngeal foreign body sensation or neck mass with hoarseness .14 cases of hypopharyngeal carcinoma with cervical esophageal involvement. Unilateral piriform sinus and cervical esophagus were involved in 9 cases (9/14) while bilateral piriform sinus, posterior pharyngeal wall and cervical esophagus were involved in 5 cases. After resection of laryngeal, pharyngeal and esophageal tumors and bilateral neck dissection, direct anastomosis of larynx and trachea with esophagus of cervico-thoracic segment was performed when circular structure of larynx and trachea could be preserved. Postoperative radiochemotherapy was adopted and follow-up lasted for 3–10 years. Table 1 Demographic characteristics of patients (N = 14) Number Age(year) Gender Smoking Alcohol use PS and CE were involved 60 Male Female Ever Never Ever Never Unilateral Other 14 5 9 14 0 10 4 9 5 9 5 PS = Piriform sinus; CE = cervical esophagus Surgery After the resection of the piriform fossa and the affected side, the retained cartilage stent of the healthy side should be removed as far as possible, and make a flexible broad laryngeal mucosa flap or laryngeal tracheal mucosa flap, which can be repaired directly with the residual hypopharynyngeal and esophageal mucosa, and a permanent tracheostomy is performed at the upper end of the trachea lime light(Fig. 1 , Fig. 2 ). One or both superior laryngeal arteries were retained༎ Two patients with pharyngoesophageal stenosis causing feeding difficulties were given nasogastric tube nasal feeding and urinary catheter dilation after scar tissue was removed by coblator plasma surgery at the stenosis and were fed to the nasogastric tube for 1–3 months. Results All cases healed without event except for one case of pharyngocutaneous fistula which also healed after about 2 weeks dressing change. All patients had good swallowing reflex, fed on normal diet free of feeding tube and no gastric reflux. Postoperative radiochemotherapy was adopted and follow-up lasted for 3–10 years. With a follow-up of 3–10 years, there was no recurrence in 9 patients, 3 patients had metastases in the neck, 1 patient had metastases in the lung and 1 patient had thoracic esophageal carcinoma with hepatic metastasis arid gave up further treatment. In post-operative 14 months, there are two patients with pharyngoesophageal stenosis(Fig. 3 ) causing feeding difficulties were given nasogastric tube nasal feeding and urinary catheter dilation(Fig. 4 ) after scar tissue was removed by coblator plasma surgery at the stenosis and were fed to the nasogastric tube for 1–3 months( Fig. 5 ). Discussion Many reconstructive methods have been used in a variety of different situations when carrying out reconstruction of the hypopharynx, such as use pectoralis major, clavicle epithelial flap, or free flap repair (e. g. forearm free flap), gastric pull-up and so on to reconstruct cervical esophagus [ 5 , 6 , 7 ]. All of the methods have their advantages and limitations. The laryngotracheal flap (LTF) was used to solve the defection of cervical esophagus in 1991[ 8 ]. Although there is preservation of the contralateral uninvolved laryngotracheal tissue, this does not seem to increase the tumor recurrence rate. It can also reduce the use of complicated regional or free flaps. Chu et al reported that 75% of the hypopharyngeal defects could be reconstructed with this flap without other flaps [ 9 ]. Postoperative complications are rare, with only 2% of patients experiencing pharyngoesophageal stenosis and 5% having pharyngocutaneous fistula. The oncological results are also satisfactory. In the study, among the 14 patients, one patient developed pharyngocutaneous fistula(7%), two cases of pharyngoesophageal stenosis (14%) . The key to decrease complications is to preserve adequate blood supply to the LTF, so one or both superior laryngeal arteries should be retained during operation. Chu et al reported that over 80% of the defects could be reconstructed with a primary closure, and the 5-year survival rates showed no significant differences compare to other ways after LTF was used [ 10 ]. In our series, 14 patients reconstructed with a primary closure, all patients had good swallowing reflex, fed on normal diet free of feeding tube and no gastric reflux. With a follow-up of 3–10 years, there was no recurrence in 9 patients, 3 patients had metastases in the neck, 1 patient had metastases in the lung and 1 patient had thoracic esophageal carcinoma with hepatic metastasis arid gave up further treatment. Pharyngoesophageal stenosis (PES) are among the most common complications following cervical esophageal reconstruction by means of laryngo-tracheal flap; they have adverse effects on post-operative rehabilitation, adjuvant therapy, and overall survival. The manage of pharyngoesophageal stenosis of postoperative is one of the most challenging and controversial problems facing the head and neck surgeon. A number of different PES repair techniques have been described [ 11 , 12 , 13 ]. In the study, two patients with pharyngoesophageal stenosis causing feeding difficulties were given nasogastric tube nasal feeding and urinary catheter expansion after scar tissue was removed by coblator plasma surgery at the stenosis and were fed to the nasogastric tube for 1–3 months. Functionally, two patients had good swallowing reflex, fed on normal diet free of feeding tube and no gastric reflux. The operation of urinary catheter dilation is simple, patient’s tolerance is good, it is easy to fixed and no easy to fall off. In general, using laryngo-tracheal flap to reconstruct cervical esophagus after resection of hypopharyngeal carcinoma with cervical esophageal involvement is a recommendable method that is simple, convenient, with high success rate and low complications (complications are mainly pharyngocutaneous fistula and pharyngoesophageal stenosis), which can be effectively used for the repair of postoperative defects of hypopharyngeal cancer. The disadvantage is that the throat is sacrificed and insufficient for the large defect tissue. Coblator plasma surgery and catheter dilation can effectively handle the problem of eating difficulties in patients with postoperative pharyngoesophageal stenosis. Declarations Open Access I confirm that I understand European Journal of Medical Research is an open access journal that levies an article processing charge per articles accepted for publication. By submitting my article I agree to pay this charge in full if my article is accepted for publication. Competing Interests No, I declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Dual Publication The results/data/figures in this manuscript have not been published elsewhere, nor are they under consideration (from you or one of your Contributing Authors) by another publisher. Authorship I have read the Nature Portfolio journal policies on author responsibilities and submit this manuscript in accordance with those policies. Third Party Material All of the material is owned by the authors and/or no permissions are required. Data Availability No, I do not have any research data outside the submitted manuscript file. Ethical Approved Ethical approval was obtained from The First Affiliated Hospital,College of Medicine, Zhe Jiang University Research Ethics Committee.All procedures were performed in accordance with the principles of Declaration of Helsinki. Funding Not applicable. References Johnson DE, et al. Head and neck squamous cell carcinoma. Nat Rev Dis Primers. 2020;6(1):92. Barsouk A, et al. Epidemiology, Risk Factors, and Prevention of Head and Neck Squamous Cell Carcinoma.Med Sci (Basel). 2023;11(2):42. Cramer JD, et al. The changing therapeutic landscape of head and neck cancer.Nat Rev Clin Oncol. 2019 ;16(11):669-683. Chen H C, et al. Thirty-five years of single surgeon experience in the reconstruction of esophagus and voice with free ileocolon flap following total pharyngolaryngectomy. J Surg Oncol. 2018;117(03):459–468. Lee ZH, Hanasono MM. Pharyngeaoesophageal Reconstruction. Otolaryngol Clin North Am. 2023;56(4):687-702. Lai YS, Lee YC. Comparison of outcomes between circumferential and near-circumferential pharyngoesophageal reconstruction using anterolateral thigh flap. J Plast Reconstr Aesthet Surg. 2023;85:316-325. Song Ni , et al . Gastric pull-up reconstruction combined with free jejunal transfer (FJT) following total pharyngolaryngo-oesophagectomy (PLE). Int J Surg. 2015:18:95-8. Tai SK, Chang SY. Contralateral hemilaryngotracheal flap reconstruction of the hypopharynx in pyriform carcinoma resection. Laryngoscope 1999;109:221–5. Chu PY, Chang SY. Reconstruction of circumferential pharyngoesophageal defects with laryngotracheal flap and pectoralis major myocutaneous flap. Head Neck 2002;24:933–9. Chu PY, Chang SY. Reconstruction after resection of hypopharyngeal carcinoma: comparison of the postoperative complications and oncologic results of different methods. Head Neck 2005;27:901–8. Spaulding SL, et al. Diagnosis and management of pharyngoesophageal stenosis: A comprehensive approach to prophylactic, endoscopic, and reconstructive treatment options.Am J Otolaryngol. 2021;42(5):103003. Poissonnet V, et al.Tracheoesophageal fistula and pharyngoesophageal stenosis repair by double skin paddle radial forearm flap.Eur Ann Otorhinolaryngol Head Neck Dis. 2022;139(5):297-300. Gilardi A, et al. A New Montgomery Salivary Bypass Tube Placement Technique: Report of Procedures Performed on Patients With Tracheoesophageal Fistula or Pharyngoesophageal Stenosis. Ear Nose Throat J. 2023;102(5):NP220-NP222. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4282382","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":295759201,"identity":"aad6a12d-9153-420f-bffd-d96506da0be3","order_by":0,"name":"qian qiyong","email":"","orcid":"","institution":"Zhejiang University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"qian","middleName":"","lastName":"qiyong","suffix":""},{"id":295759202,"identity":"16c3cec8-931c-4f18-b08b-049e8d4a4820","order_by":1,"name":"wang 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13:59:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4282382/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4282382/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55767195,"identity":"b02e893e-92ba-4c87-a0a1-4447442dc35e","added_by":"auto","created_at":"2024-05-02 20:16:32","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":603190,"visible":true,"origin":"","legend":"\u003cp\u003eThe made of laryngo-tracheal flap.\u003c/p\u003e","description":"","filename":"FIG1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4282382/v1/54aa0fbb60ba0e55fb753f4b.jpg"},{"id":55767198,"identity":"5c4eba4f-3014-4cd2-b8d3-2ecc2bdb8f77","added_by":"auto","created_at":"2024-05-02 20:16:32","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":497524,"visible":true,"origin":"","legend":"\u003cp\u003eUsing laryngo-tracheal flap to reconstruct cervical esophagus after resection of hypopharyngeal carcinoma with cervical esophageal involving．\u003c/p\u003e","description":"","filename":"FIG2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4282382/v1/ebb18bac51c4a4c7adeb9196.jpg"},{"id":55767194,"identity":"2c12c492-07be-4218-9a82-15677d77f7b9","added_by":"auto","created_at":"2024-05-02 20:16:32","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":379090,"visible":true,"origin":"","legend":"\u003cp\u003eThe laryngoscope and electrogastroscopy shown pharyngoesophageal stenosis after postoperative14 months.\u003c/p\u003e","description":"","filename":"FIG3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4282382/v1/3ddfc45883ab8cdba3ffc332.jpg"},{"id":55767196,"identity":"bfafde37-a0ef-4492-9d66-9aabe2d68986","added_by":"auto","created_at":"2024-05-02 20:16:32","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":347340,"visible":true,"origin":"","legend":"\u003cp\u003eNasogastric tube and urinary catheter were placed to dilate pharyngoesophageal stenosis after scar tissue was removed by coblator plasma surgery at the stenosis\u003c/p\u003e","description":"","filename":"FIG4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4282382/v1/099e2bcfc350623b5baa0d31.jpg"},{"id":55768548,"identity":"8a888401-78f7-419c-a393-a38a2b3a6533","added_by":"auto","created_at":"2024-05-02 20:32:32","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":147992,"visible":true,"origin":"","legend":"\u003cp\u003eCT shown the patient fed on normal diet free of feeding tube and no gastric reflux after urinary catheter expansion.\u003c/p\u003e","description":"","filename":"FIG5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4282382/v1/00452ab3a5885e85532b7446.jpg"},{"id":58096920,"identity":"5bb654b2-d057-44e0-982d-ce74ece64f95","added_by":"auto","created_at":"2024-06-11 05:55:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2259587,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4282382/v1/9534c617-d89d-425f-b1e8-d0e9016cf0db.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Significance of Laryngo-tracheal flap to reconstruct the defect and management of pharyngoesophageal stenosis after resection of the hypopharyngeal carcinoma with cervical esophagus involvement","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSquamous cell carcinoma of the hypopharynx (HPSCC) usually presents with an advanced stage and generally has a poor prognosis. The reasons for this poor prognosis are late presentation, submucosal spreading and early lymphatic/distant metastasis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Surgery with postoperative radiation or chemoradiation therapy has been the standard treatment for HPSCC, although an organ preservation protocol with chemoradiation therapy has become more popular in recent years [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In a review of the literature, only 15\u0026ndash;34% of HPSCC patients are suitable for conservation surgery that is able to preserve laryngeal functioning. Most patients need radical surgery, which includes total laryngectomy, partial or total pharyngectomy and/or esophagectomy. Radical surgery may result in a large surgical defect of thehypopharyngeal and cervical esophageal regions. Therefore, reconstruction of the surgical defect is important in order to restore the continuity of the gastrointestinal tract and allow oral alimentation. There are many ways to solve hypopharyngeal defection, such as use pectoralis major, clavicle epithelial flap, or free flap repair (e. g. forearm free flap), gastric pull-up and so on to reconstruct cervical esophagus [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. But ,when the patient needs total laryngectomy, and the laryngeal cavity stent and mucosa are not invaded by the tumor, the larynx and esophagus can be considered༎\u003c/p\u003e \u003cp\u003eFor hypopharyngeal cancer involving cervical esophagus(CE) invasion throat, resection under the pharynx and part of the throat, throat abandoned unfortunately, using residual throat repair pharynx and cervical esophageal defect, trachea and esophagus, both to pharyngeal cancer radical resection, and make full use of the residual throat, solve the problem of cervical esophageal material, is pharyngeal cancer involving cervical esophagus combined laryngeal invasion very valuable way of surgery༎\u003c/p\u003e"},{"header":"Metheds","content":"\u003cp\u003eThe participant in this report signed informed consent, participated voluntarily, and had the right to withdraw at any stage. Ethical approval was obtained from The First Affiliated Hospital,College of Medicine, Zhe Jiang University Research Ethics Committee.All procedures were performed in accordance with the principles of Declaration of Helsinki.\u003c/p\u003e \u003cp\u003eClinical samples and data collection\u003c/p\u003e \u003cp\u003eThe clinical data of 14 patients with postoperative defects of residual laryngeal repair during 2012\u0026ndash;2021, and the management strategies of two patients with complicated laryngopharyngeal stenosis were analyzed(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)༎All 14 patients were male, aged 51 to 80 years and median age 69.5 years༎10 of the 14 patients had a history of smoking and 9 patients had alcohol consumption. The main manifestations are sore throat, pharyngeal foreign body sensation or neck mass with hoarseness .14 cases of hypopharyngeal carcinoma with cervical esophageal involvement. Unilateral piriform sinus and cervical esophagus were involved in 9 cases (9/14) while bilateral piriform sinus, posterior pharyngeal wall and cervical esophagus were involved in 5 cases. After resection of laryngeal, pharyngeal and esophageal tumors and bilateral neck dissection, direct anastomosis of larynx and trachea with esophagus of cervico-thoracic segment was performed when circular structure of larynx and trachea could be preserved. Postoperative radiochemotherapy was adopted and follow-up lasted for 3\u0026ndash;10 years.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of patients (N\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge(year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAlcohol use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePS and CE were involved\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;60 \u0026gt;60\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale Female\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEver Never\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEver Never\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnilateral Other\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003ePS\u0026thinsp;=\u0026thinsp;Piriform sinus; CE\u0026thinsp;=\u0026thinsp;cervical esophagus\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003cp\u003eAfter the resection of the piriform fossa and the affected side, the retained cartilage stent of the healthy side should be removed as far as possible, and make a flexible broad laryngeal mucosa flap or laryngeal tracheal mucosa flap, which can be repaired directly with the residual hypopharynyngeal and esophageal mucosa, and a permanent tracheostomy is performed at the upper end of the trachea lime light(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). One or both superior laryngeal arteries were retained༎\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTwo patients with pharyngoesophageal stenosis causing feeding difficulties were given nasogastric tube nasal feeding and urinary catheter dilation after scar tissue was removed by coblator plasma surgery at the stenosis and were fed to the nasogastric tube for 1\u0026ndash;3 months.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAll cases healed without event except for one case of pharyngocutaneous fistula which also healed after about 2 weeks dressing change. All patients had good swallowing reflex, fed on normal diet free of feeding tube and no gastric reflux. Postoperative radiochemotherapy was adopted and follow-up lasted for 3\u0026ndash;10 years.\u003c/p\u003e \u003cp\u003eWith a follow-up of 3\u0026ndash;10 years, there was no recurrence in 9 patients, 3 patients had metastases in the neck, 1 patient had metastases in the lung and 1 patient had thoracic esophageal carcinoma with hepatic metastasis arid gave up further treatment. In post-operative 14 months, there are two patients with pharyngoesophageal stenosis(Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e ) causing feeding difficulties were given nasogastric tube nasal feeding and urinary catheter dilation(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) after scar tissue was removed by coblator plasma surgery at the stenosis and were fed to the nasogastric tube for 1\u0026ndash;3 months( Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e ).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMany reconstructive methods have been used in a variety of different situations when carrying out reconstruction of the hypopharynx, such as use pectoralis major, clavicle epithelial flap, or free flap repair (e. g. forearm free flap), gastric pull-up and so on to reconstruct cervical esophagus [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. All of the methods have their advantages and limitations.\u003c/p\u003e \u003cp\u003eThe laryngotracheal flap (LTF) was used to solve the defection of cervical esophagus in 1991[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Although there is preservation of the contralateral uninvolved laryngotracheal tissue, this does not seem to increase the tumor recurrence rate. It can also reduce the use of complicated regional or free flaps. Chu et al reported that 75% of the hypopharyngeal defects could be reconstructed with this flap without other flaps [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Postoperative complications are rare, with only 2% of patients experiencing pharyngoesophageal stenosis and 5% having pharyngocutaneous fistula. The oncological results are also satisfactory. In the study, among the 14 patients, one patient developed pharyngocutaneous fistula(7%), two cases of pharyngoesophageal stenosis (14%) .\u003c/p\u003e \u003cp\u003eThe key to decrease complications is to preserve adequate blood supply to the LTF, so one or both superior laryngeal arteries should be retained during operation.\u003c/p\u003e \u003cp\u003eChu et al reported that over 80% of the defects could be reconstructed with a primary closure, and the 5-year survival rates showed no significant differences compare to other ways after LTF was used [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In our series, 14 patients reconstructed with a primary closure, all patients had good swallowing reflex, fed on normal diet free of feeding tube and no gastric reflux. With a follow-up of 3\u0026ndash;10 years, there was no recurrence in 9 patients, 3 patients had metastases in the neck, 1 patient had metastases in the lung and 1 patient had thoracic esophageal carcinoma with hepatic metastasis arid gave up further treatment.\u003c/p\u003e \u003cp\u003ePharyngoesophageal stenosis (PES) are among the most common complications following cervical esophageal reconstruction by means of laryngo-tracheal flap; they have adverse effects on post-operative rehabilitation, adjuvant therapy, and overall survival. The manage of pharyngoesophageal stenosis of postoperative is one of the most challenging and controversial problems facing the head and neck surgeon. A number of different PES repair techniques have been described [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In the study, two patients with pharyngoesophageal stenosis causing feeding difficulties were given nasogastric tube nasal feeding and urinary catheter expansion after scar tissue was removed by coblator plasma surgery at the stenosis and were fed to the nasogastric tube for 1\u0026ndash;3 months. Functionally, two patients had good swallowing reflex, fed on normal diet free of feeding tube and no gastric reflux. The operation of urinary catheter dilation is simple, patient\u0026rsquo;s tolerance is good, it is easy to fixed and no easy to fall off.\u003c/p\u003e \u003cp\u003eIn general, using laryngo-tracheal flap to reconstruct cervical esophagus after resection of hypopharyngeal carcinoma with cervical esophageal involvement is a recommendable method that is simple, convenient, with high success rate and low complications (complications are mainly pharyngocutaneous fistula and pharyngoesophageal stenosis), which can be effectively used for the repair of postoperative defects of hypopharyngeal cancer. The disadvantage is that the throat is sacrificed and insufficient for the large defect tissue. Coblator plasma surgery and catheter dilation can effectively handle the problem of eating difficulties in patients with postoperative pharyngoesophageal stenosis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eOpen Access\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI confirm that I understand European Journal of Medical Research is an open access journal that levies an article processing charge per articles accepted for publication. By submitting my article I agree to pay this charge in full if my article is accepted for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo, I declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDual Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results/data/figures in this manuscript have not been published elsewhere, nor are they under consideration (from you or one of your Contributing Authors) by another publisher.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthorship\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI have read the Nature Portfolio journal policies on author responsibilities and submit this manuscript in accordance with those policies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThird Party Material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll of the material is owned by the authors and/or no permissions are required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo, I do not have any research data outside the submitted manuscript file.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approved\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from The First Affiliated Hospital,College of Medicine, Zhe Jiang University Research Ethics Committee.All procedures were performed in accordance with the principles of Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJohnson DE, et al. Head and neck squamous cell carcinoma. Nat Rev Dis Primers. 2020;6(1):92.\u003c/li\u003e\n\u003cli\u003eBarsouk A, et al. Epidemiology, Risk Factors, and Prevention of Head and Neck Squamous Cell Carcinoma.Med Sci (Basel). 2023;11(2):42.\u003c/li\u003e\n\u003cli\u003eCramer JD, et al. The changing therapeutic landscape of head and neck cancer.Nat Rev Clin Oncol. 2019 ;16(11):669-683.\u003c/li\u003e\n\u003cli\u003eChen H C, et al. Thirty-five years of single surgeon experience in the reconstruction of esophagus and voice with free ileocolon flap following total pharyngolaryngectomy. J Surg Oncol. 2018;117(03):459\u0026ndash;468.\u003c/li\u003e\n\u003cli\u003eLee ZH, Hanasono MM. Pharyngeaoesophageal Reconstruction. Otolaryngol Clin North Am. 2023;56(4):687-702.\u003c/li\u003e\n\u003cli\u003eLai YS, Lee YC. Comparison of outcomes between circumferential and near-circumferential pharyngoesophageal reconstruction using anterolateral thigh flap. J Plast Reconstr Aesthet Surg. 2023;85:316-325.\u003c/li\u003e\n\u003cli\u003eSong Ni , et al . Gastric pull-up reconstruction combined with free jejunal transfer (FJT) following total pharyngolaryngo-oesophagectomy (PLE). Int J Surg. 2015:18:95-8. \u003c/li\u003e\n\u003cli\u003eTai SK, Chang SY. Contralateral hemilaryngotracheal flap reconstruction of the hypopharynx in pyriform carcinoma resection. \u003cem\u003eLaryngoscope \u003c/em\u003e1999;109:221\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eChu PY, Chang SY. Reconstruction of circumferential pharyngoesophageal defects with laryngotracheal flap and pectoralis major myocutaneous flap. \u003cem\u003eHead Neck \u003c/em\u003e2002;24:933\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eChu PY, Chang SY. Reconstruction after resection of hypopharyngeal carcinoma: comparison of the postoperative complications and oncologic results of different methods. \u003cem\u003eHead Neck \u003c/em\u003e2005;27:901\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eSpaulding SL, et al. Diagnosis and management of pharyngoesophageal stenosis: A comprehensive approach to prophylactic, endoscopic, and reconstructive treatment options.Am J Otolaryngol. 2021;42(5):103003.\u003c/li\u003e\n\u003cli\u003ePoissonnet V, et al.Tracheoesophageal fistula and pharyngoesophageal stenosis repair by double skin paddle radial forearm flap.Eur Ann Otorhinolaryngol Head Neck Dis. 2022;139(5):297-300.\u003c/li\u003e\n\u003cli\u003eGilardi A, et al. A New Montgomery Salivary Bypass Tube Placement Technique: Report of Procedures Performed on Patients With Tracheoesophageal Fistula or Pharyngoesophageal Stenosis. Ear Nose Throat J. 2023;102(5):NP220-NP222.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"hypopharyngeal cancer, functional reconstruction, surgery","lastPublishedDoi":"10.21203/rs.3.rs-4282382/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4282382/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThere are many ways to solve hypopharyngeal defection, such as use pectoralis major, clavicle epithelial flap, or free flap repair (e. g. forearm free flap), gastric pull-up and so on to reconstruct cervical esophagus. In the study, we investigate cervical esophageal reconstruction by means of laryngo-tracheal flap and the management of postoperative pharyngoesophageal stenosis after resection of hypopharyngeal carcinoma with cervical esophageal involvement. All 14 cases had good swallowing reflex, fed on normal diet free of feeding tube and no gastric reflux. With a follow-up of 3-10 years, there was no recurrence in 9 patients, 3 patients had metastases in the neck, 1 patient had metastases in the lung and 1 patient had thoracic esophageal carcinoma with hepatic metastasis arid gave up further treatment. Among the 14 patients, one patient developed pharyngocutaneous fistula, and the remaining patients recovered well. Two patients with pharyngoesophageal stenosis causing feeding difficulties were given nasogastric tube nasal feeding and urinary catheter dilation after scar tissue was removed by coblator plasma surgery at the stenosis and were fed to the nasogastric tube for 1-3 months. Accordingly, using laryngo-tracheal flap to reconstruct cervical esophagus after resection of hypopharyngeal carcinoma with cervical esophageal involvement is a recommendable method that is simple, convenient, with high success rate and low complications (complications are mainly pharyngocutaneous fistula and pharyngoesophageal stenosis), which can be effectively used for the repair of postoperative defects of hypopharyngeal cancer. The disadvantage is that the throat is sacrificed and insufficient for the large defect tissue. Coblator plasma surgery and urinary catheter dilation can effectively handle the problem of eating difficulties in patients with postoperative pharyngoesophageal stenosis.\u003c/p\u003e","manuscriptTitle":"Significance of Laryngo-tracheal flap to reconstruct the defect and management of pharyngoesophageal stenosis after resection of the hypopharyngeal carcinoma with cervical esophagus involvement","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-02 20:16:27","doi":"10.21203/rs.3.rs-4282382/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a0017f66-508a-42e7-964d-7d13cac59de7","owner":[],"postedDate":"May 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-26T11:53:18+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-02 20:16:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4282382","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4282382","identity":"rs-4282382","version":["v1"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}