Retrospective analysis of surgical outcomes of delayed pharyngeal defect reconstruction in patients with advanced laryngeal and laryngopharyngeal cancer after laryngectomy

Aim – to retrospectively analyze the results of surgical treatment of delayed reconstruction of pharyngeal defects in patients with advanced laryngeal and laryngopharyngeal cancer after laryngectomy. Material and methods. We performed a retrospective analysis of 437 case histories of patients treated in Samara Regional Clinical Oncology Center in the period from 2015 to 2019 with malignant neoplasms of the larynx and laryngeal pharynx, who had previously undergone combined and extended-combined laryngectomies. In the retrospective analysis, we studied the structure of complications after delayed reconstructive surgeries of type 0-II pharyngeal and pharyngo-esophageal defects. Local tissue, pectoral flap, and deltopectoral flap were used as plastic material. Complications in the postoperative period were observed in all types of plasty. Results. The most frequent complications included inflammation of the postoperative wound, anastomosis failure with subsequent formation of fistulas or secondary faryngostomas. In type 0 pharyngeal defects, plastic surgery with the use of local tissues showed a good result, postoperative complications occurred in 11% of cases. In I type pharyngeal defects, fistulas and secondary stomas in the postoperative period were formed in 83% of cases when local tissues were used, in 45.8% when pectoral flap was used and in 66.5% when deltopectoral flap was used. In type II of the defect, the percentage of postoperative complications when using a pectoral flap was 75% and deltopectoral flap – 100%. Conclusion. Complications in the postoperative period were observed in all types of plasty. The study of risk factors and creation of the algorithm for selection of patients for delayed plasty will allow to determine the terms and indications for delayed reconstructive-reconstructive surgery, as well as to reasonably reduce the risk of postoperative complications.