Results
The case series includes 8 patients (Male:Female = 4:4 with a mean age
of 68.6 years (range 55-82). Five procedures were performed as primary
circumferential laryngopharyngectomies, and three patients underwent
salvage operations following previous radical chemoradiotherapy (7
years, 9 years and 28 years prior to surgery). Primary tumour maximal
diameters ranged from 17–75 mm (mean: 41.6 mm).
The anterior pharyngeal wall was reconstructed with a pectoralis major
flap for 5 patients and a supraclavicular flap for the remaining 3
patients. All patients developed a small pharyngocutaneous fistula,
laterally in the neck, over the 3-point junction of the DP flap. In all
patients this required no intervention, did not result in wound
dehiscence, and closed spontaneously within 4-28 days (mean: 15.6). For
the three patients requiring adjuvant (chemo)radiotherapy, there was no
delay in treatment delivery.
Functional outcomes were favourable in the majority of patients. All
patients have achieved normal (n=2) or soft (n=6) diet, although one
individual continues to require PEG tube dietary supplementation. Of the
6 patients that manage soft diet, one developed a low neopharyngeal
stricture requiring repeated dilatations. A speech valve has been
inserted in 4 patients, with all achieving intelligible speech, 2
patients are awaiting tracheo-oeosophageal puncture which has been
postponed during the COVID-19 pandemic. Speech valve insertion was not
possible for 2 patients, as the oesophagectomy level is significantly
below the level of the stoma. Two patients died during follow up, one
following tumour recurrence, and one unrelated to their malignancy. All
results are summarised in table 1.