Comparison of the Swallowing Function After Reconstruction of Cervical Esophagus with Jejunum, Ileocolon or Skin Flap: Method of Physiotherapy for Deglution and Long Term Follow-Up.

The swallowing function is a major goal of reconstruction for the patients who had hypopharyngeal cancer and received total pharyngolaryngectomy with or without voice reconstruction. We would like to share our experience in reconstruction of swallowing function using jejunum, ileocolon, or anterolateral thigh flap for cervical esophagus. In this study, we proposed that the jejunum flap is the most suitable option for restoring swallowing function, owing to its physiological characteristics. A retrospective study was conducted in 36 patients undergoing reconstruction of cervical esophagus with free jejunum flap (7 cases), ileocolon flap (21 cases), or anterolateral flap (8 cases). Esophagography, time required to achieve swallowing of semisolid diet without tube feeding, changes in body weight before and after the surgery, and ^99mTc for transit scan to evaluate pharyngeal clearance were used to evaluate the swallowing function of the patients. Patients with jejunum flap had the best swallowing function, followed by ileocolon and then ALT flap. Besides, no conduits needed to be modified in jejunum and ileocolon flap. Regarding swallowing function, for patients with longer life expectancy and no contraindication of laparotomy, jejunum flap should be the first choice to obtain optimal swallowing function for cervical esophagus. Anterolateral flap is the easiest and most commonly used flap and provides fair swallowing function if there is no leakage. However, the anterolateral thigh flap tends to develop narrowing on long-term following-up. Based on completeness of pharyngeal transit of bolus and lack of complications, patients with jejunal flap reconstruction showed best swallowing function, followed by ileocolon and then ALT flaps.