The latest results of the advanced hypopharyngeal cancer surgery with immediate reconstruction using the free jejunal autograft

: In 21 patients with T3, T4 pharyngo-laryngeal cancer circumferential resection with immediate reconstruction using a free revascularized jejunal autograft was performed. In 13 cases the jejunal reconstruction was successful. In patients previously not irradiated the rate of success was 75% and in irradiated ones 37.5%. Five patients survived more than 5 years: one more than 7, two more than 6 and one more than 5. One patient with an unsuccessful jejunal graft and with subsequent skin reconstruction survived more than 6 years. The causes of failure were:-irreversible spasm of the arteries in 2 cases, skinking of the vessels resulting in flap necrosis in flap necrosis in 2 cases, -necrosis due to widespread atherosclerosis of the cervical arteries in 3 cases and of an unknown cause in 1 case. The cause of death was: widespread metastases in 12 cases, C.V.A. in 1 case, road traffic accident in 1 case, complications of the ileus in 1 case and carotid artery haemorrhage in 1 case. One of the successful patients was irradiated postoperatively, because the pathology report stated there was incomplete resection, and survived more than 6 years with no disturbance of swallowing. In general 10 patients died in the first year, 4 in the second, 1 in the third and 1 in the fourth--without any signs of recurrence. The five year survival of 24% in the presented group is relatively high in comparison with the generally accessible data for T3, T4 hypopharyngeal carcinoma treated by any of the usual methods.