Results
The case series includes 8 patients (Male:Female = 4:4 with a mean age of 68.6 years (range 55-82). Five procedures were performed as primary circumferential laryngopharyngectomies, and three patients underwent salvage operations following previous radical chemoradiotherapy (7 years, 9 years and 28 years prior to surgery). Primary tumour maximal diameters ranged from 17–75 mm (mean: 41.6 mm).
The anterior pharyngeal wall was reconstructed with a pectoralis major flap for 5 patients and a supraclavicular flap for the remaining 3 patients. All patients developed a small pharyngocutaneous fistula, laterally in the neck, over the 3-point junction of the DP flap. In all patients this required no intervention, did not result in wound dehiscence, and closed spontaneously within 4-28 days (mean: 15.6). For the three patients requiring adjuvant (chemo)radiotherapy, there was no delay in treatment delivery.
Functional outcomes were favourable in the majority of patients. All patients have achieved normal (n=2) or soft (n=6) diet, although one individual continues to require PEG tube dietary supplementation. Of the 6 patients that manage soft diet, one developed a low neopharyngeal stricture requiring repeated dilatations. A speech valve has been inserted in 4 patients, with all achieving intelligible speech, 2 patients are awaiting tracheo-oeosophageal puncture which has been postponed during the COVID-19 pandemic. Speech valve insertion was not possible for 2 patients, as the oesophagectomy level is significantly below the level of the stoma. Two patients died during follow up, one following tumour recurrence, and one unrelated to their malignancy. All results are summarised in table 1.