LAUSR

Malignancies located at the level of the upper esophageal sphincter pose a challenge due to the proximity to pharyngeal, laryngeal, and upper esophageal anatomic structures. Poorly differentiated tumors in this area can pose both diagnostic and therapeutic dilemmas, and patients with prior neck radiation may require surgery. In cases that are treated with laryngectomy, pharyngectomy, and proximal esophagectomy, jejunal free flap reconstruction can restore gastrointestinal continuity and function. A single institution early experience with multidisciplinary complex head and neck reconstruction requiring pharyngectomy and proximal esophagectomy was reviewed. Charts were reviewed for demographic details, operative details, and 30 day perioperative occurrences. Radiographic, clinical, and endoscopic records were reviewed. Method and approach for jejunal harvest and abdominal complications were obtained. Location of microvascular anastomoses were recorded for implantation of the jejunum. Length of small bowel utilized was recorded along with details of operative technique and methods for both proximal and distal anastomoses. Pre-operative and post-operative pathology reports were reviewed and compared. The initial 4 cases of pharyngeal and esophageal resection requiring jejunal free flap reconstruction were reviewed. Mean age was 65.3 (50-74), mean BMI was 31.7 (21.7-49.8), and 75% of patients were female. Median length of stay was 13.5 days (8-14) after the index operation. Flap survival rate was 100%, and there was 0% leak rate. Three patients had previous neck surgery, 75% survived to 30 days with 1 patient opting for palliative care. All flaps were harvested using a laparoscopic approach. There were no abdominal donor site related complications. Pathology 50% SCC, mucoid epidermoid carcinoma, and anaplastic thyroid carcinoma. Reconstruction of complex pharyngeal and proximal esophageal defects after oncologic resection for malignancy involving the proximal esophagus abutting the upper esophageal sphincter poses a complex challenge. These proximal esophageal defects are managed effectively with jejunal free flap reconstruction utilizing microvascular anastomoses. A double lumen jejunal free flap should be considered to restore pharygo-esophageal continuity, provides good pharyngeal size match, and can also be safely performed in patients with a re-operative field or prior neck radiation.