Salvage Total Pharyngolaryngectomy and Free Jejunum Transfer

Objectives/Hypothesis: The objective of this retrospective study was to examine the safety and efficacy of free jejunum transfer after total pharyngolaryngectomy after radiotherapy (RT) or chemoradiotherapy (CRT) to the neck for patients with recurrent or second primary disease. Study Design: Retrospective study. Methods: A total of 313 patients were divided into two groups on the basis of a history of RT to the neck: 86 patients had received RT and 227 patients had not. The patients who had received RT were subdivided on the basis of the type of previous treatment: those who had received RT alone (32 patients) and those who had undergone concurrent CRT (54 patients). Postoperative complications were compared between RT and non-RT groups and between the RT-alone and CRT groups. Results: The rates of complications did not differ significantly between the RT and non-RT groups, but the rates of anastomotic thrombosis and carotid rupture were slightly but not significantly higher in the RT group than in the non-RT group. The overall complication rate did not differ between the RT-alone group and the CRT group. Conclusions: Pharyngolaryngectomy and free jejunum transfer can be performed safely, even in patients who have received RT, without significant increases in morbidity or mortality. However, a risk of carotid rupture due to pharyngocutaneous fistula remains in patients who have received RT, and prevention and early detection of fistulas are crucial. The risk of postoperative complications is not higher with CRT than with RT alone.