FREE REVASCULARIZED JEJUNAL LOOP REPAIR FOLLOWING TOTAL PHARYNGOLARYNGECTOMY FOR CARCINOMA OF THE HYPOPHARYNX - REPORT OF 90 PATIENTS

Ninety patients with carcinoma of the hypopharynx underwent pharyngola ryngectomy and reconstruction with a jejunal free autograft. Fifty-fiv e patients had primary surgery and 35 salvage surgery for recurrence a fter radiotherapy. Following primary surgery 28 patients had postopera tive radiotherapy and 27 did not. Complications occurred in 51 per cen t of patients, the most common being necrosis of the jejunal graft (19 per cent); 12 per cent developed significant stenosis and 4 per cent died in the perioperative period. Eleven per cent of patients develope d a fistula. The total number of complications diminished as the exper ience of the unit increased. Median follow-up was 4. 9 years. Of patie nts treated with primary surgery, 48 per cent developed primary site r ecurrence (at 3 years) and 53 per cent neck node recurrence (at 5 year s). The tumour-specific S-year survival rate for all patients was 42 p er cent. Following primary surgery 28 per cent survived for 5 years an d after salvage surgery the rate was 59 per cent. Positive resection m argins and extensive neck disease adversely affected survival (P=0.02 and P=0.001 respectively). The free revascularized jejunal graft is a safe and predictable method of repair following total pharyngolaryngec tomy.