746 EXPERIENCE IN RECONSTRUCTION OF LARYNGOPHARYNGOESOPHAGECTOMIES IN A THIRD LEVEL CENTER

Pharyngoesophageal reconstruction after laryngo-pharyngo-esophagectomy, due to malignant or benign causes, is challenging due to its high morbidity and mortality. There are different reconstructive flaps: visceral flaps (pedicle stomach and colon flaps and free jejunum or colon grafts) and myocutaneous flaps (pedicle local flaps, such as the pectoralis major flap, or free grafts, such as the anterolateral thigh-ALT). The objective is to evaluate the morbidity and mortality and functional results of the reconstruction after laryngo-pharyngo-esophagectomy. Methods This is a retrospective study of patients who underwent laryngo-pharyngo-esophagectomy in our center, due to a benign cause (ingestion of caustic) or malignant (cancer of the larynx, pharynx, parathyroid and cervical esophagus) with circumferential pharyngeal reconstruction with flap, from 2008 to November 2020. Demographic variables, neoadjuvant treatment, procedure performed and flap used for reconstruction, complications related to reconstruction (fistula, stenosis, necrosis), postoperative complications, days until adequate swallowing, functional result of the flap, hospital stay, recurrence and mortality were collected. Results Twelve patients, with a median age of 59 years (45–78), underwent surgery, 1 case due to benign cause and 11 cases with an oncological diagnosis. There were complications related to the reconstruction in 42% of the patients (see table 1). Postoperative morbidity was 67% (75% Clavien-Dindo ≥ III). The median hospital stay was 21 days (16–94). The median time to swallowing was 13 days (3–73). An optimal functional result (oral intake) was achieved in 75% (only 3 patients with poor results). The median follow-up was 18 months (4–56), with a survival rate of 50%. 30-days mortality was 8% (1 case). Conclusion Our study shows a high morbidity and mortality after circumferential pharyngeal reconstruction, similar to literature published. We have observed a higher rate of reconstruction related complications (fistulas and stenosis) and worse functional results in reconstructions performed with gastroplasty and coloplasty after total laryngo-pharyngo-esophagectomy, compared to less aggressive local resections (laryngopharyngeal) with ALT free flap reconstruction.

Surgical treatment of acquired tracheoesophageal fistula caused by balloon dilatation of corrosive esophageal stricture in a child

Introduction. Tracheoesophageal fistula (TEF) as a complication of balloon dilatation (BD) of corrosive esophageal stricture is a very rare and serious condition. Life threatening aspiration pneumonia requests urgent lungs' protection, but overall treatment strategy is not clearly defined. Case report. Twenty-month-old female child accidentally ingested a household bleach. Caustic injury of esophagus was healing with development of strictures of cervical and proximal thoracic esophagus. TEF was developed during the third BD. Healing of TEF and pulmonary infection was achieved by exclusion of the esophagus (pharyngostoma and feeding gastrostomy together) with prolonged tracheobronchial intubation and toilette. Retrosternal colon interposition was performed a year later, with excellent functional results over four-year follow-up. Conclusion. Esophageal exclusion in the first stage, and pharyngoesophageal reconstruction in the second stage, is a useful therapeutic option in the treatment of TEF caused by balloon dilatation of corrosive esophageal stricture in children.

P203 PHARYNGOESOPHAGEAL RECONSTRUCTION AFTER LARYNGECTOMY AND RADIOTHERAPY

Aim The purpose of this presentation is to review our experience and evaluate our results in the treatment of patients with pharyngoesophageal fistula after laryngectomy and radiotherapy. Background & Methods 10 patients were examined at the head and neck combined oncology clinic after previous laryngectomy and radiotherapy and pharyngocutaneous fistula with weakness to feed food as well frequent aspiration pneumonia. The interval between the effect of the laryngectomy varies between 3-5 years depending on the severity of the symptomatology and after the complete failure of the conservative methods of reconstruction. Reconstruction was performed with musculocutaneous major pectoral flap in 8 patients, radial forearm flap and anterolateral thigh flap. Results The postoperative period was uncomplicated, and in all patients the feeding was held after barium swallow test, after 7-15 days with soft food. The gold standard treatment of pharyngoesophageal fistula after laryngectomy and radiotherapy is the musculocutaneous major pectoral flap and in severe radionecrosis of the neck with free tissue flap reconstruction. Conclusion Reconstruction with microsurgical techniques offer improved prognosis and quality of life of our patients.