This is a review of 69 patients who underwent total pharyngeal reconstruction after pharyngolaryngoesophagectomy or total pharyngolaryngectomy at A.C.Camargo Hospital over 18 years (1980 to 1996), with the propose of comparing the immediate and late results of the different types of reconstruction. The tumor was sited at the hypopharynx or larynx in 57 cases (82.6%), at cervical esophagus in seven (10.1.%) and other sites in five (7.2%). The surgery was indicated for local advanced disease in 62.4% cases and for tumor recurrence in 18.8%. There were 19 cases of pharyngolaryngoesophagectomy and 50 cases of pharyngolaryngectomy in which the primary suture of the pharynx could not be performed. The surgery type performed after pharyngolaryngoesophagectomy was a reconstruction with "gastric pull-up" in 14 patients and colonic interposition in five patients. Reconstruction after pharyngolaryngectomy was performed with a tubed pectoralis major myocutaneous flap in 16 patients, reconstruction in five patients. Reconstruction with "gastric pull-up" presented less complications than colonic interposition in the cases of pharyngolaryngoesophagectomy. In the cases of pharyngolaryngectomy the reconstruction with the pectoralis major myocutaneous flap suture at pre-vertebralis fascia presented less cases of fistula and stenosis compared with other type of reconstruction. 1n one case, these differences were not statistically significant between the reconstruction after pharyngo- laryngectomy nor between the reconstruction after pharyngolaryngoesophagectomy. 5-years survival was 27.5%, median survival was 17.2 months. According to this experience, we prefer nowadays to perform a pectoralis major myocutaneous flap suture at the pre-vertebralis fascia when, after pharyngolaryngectomy, we can not perform a primary closure of pharynx, in such cases where pharyngolaryngoesophagectomy is necessary, a reconstruction with a "gastric pull-up" is our choice.
Pharyngeal reconstruction; Pharyngolaryngoesophagectomy; Pharyngolaryngectotny