Reconstruction of cervical esophagus for hypopharyngeal or thyroid cancer with intractable leakage at the upper end of thoracic esophagus: A scoping review and the pedicled colon flap solution.

Background: Patients with advanced hypopharyngeal cancers or thyroid cancers often require pharyngoesophageal reconstruction after tumor ablation, but complications are frequent. Anastomotic leakage, particularly in patients receiving perioperative radiation therapy, poses a significant challenge. The aim of this study was to conduct a literature review on leakage management methods and present a novel approach: utilizing a pedicled colon flap to create a diverted conduit connected to the cervical neo-esophagus.

Methods: A scoping review was conducted in March 2024. Additionally, between 2004 and 2022, 17 patients underwent pedicled colon transposition to the newly reconstructed cervical neo-esophagus. Four had neoadjuvant radiation therapy for thyroid or hypopharyngeal cancer, and the pedicled colon transposition method was used to prevent anastomotic leakage after hypopharyngeal reconstruction. The other 13 suffered leakage at the junction of the cervical neo-esophagus and thoracic esophagus after reconstruction. The method involved closing the cephalic end of the thoracic esophagus and using the pedicled colon transposition to restore alimentary tract continuity.

Results: The review identified 4 leakage prevention methods. In our clinical series, colon flap harvest averaged 4.5 h with no postoperative leakage observed. All patients resumed oral intake, but 65% experienced transient diarrhea that resolved within a month.

Conclusions: For patients who receive perioperative irradiation that complicates pharyngoesophageal reconstructions, a supercharged pedicled colon flap presents a feasible solution for managing anastomotic leakage.