Reconstruction of a pharyngeal defect in the surgical treatment of locally advanced laryngopharyngeal cancer: literature review

Abstract

Relevance: In 2022, 370 new cases of newly diagnosed patients with laryngeal cancer and 151 with laryngopharyngeal cancer were registered in the Republic of Kazakhstan, of which 12.1% of laryngeal cancer at stage IV of the disease and 18.9% of laryngeal cancer. The one–year mortality rate for laryngopharyngeal lesions was 40.5%, the ratio between one-year mortality and neglect (stage IV) was 2.3%. For T3-4 laryngopharyngeal cancer, today the only operation of choice is circular resection of the laryngopharynx with laryngectomy and the formation of stomas on the neck. The prospect of disability of patients – the formation of pharyngostomy, esophagostomy, tracheostomy, constant salivation, the need for probe nutrition, etc., causes irreparable psychological damage to the patient’s personality. In this regard, the problem of pharyngeal and laryngopharyngeal reconstruction in cancer patients becomes extremely important not only as a stage of rehabilitation, but also as a necessary element in terms of antitumor treatment of this complex category of patients.

The study aimed to assess the significance of pharyngeal defect reconstruction in the surgical treatment of laryngopharyngeal cancer in order to improve the rehabilitation of cancer patients and optimize antitumor treatment.

Methods: Scientific publications were searched in the following databases: PubMed, Medline, eLibrary, Cochrane Lab, using the scientific search engine Google Scholar. Criteria for inclusion of publications in the literary review: publications in Russian and English; publications included in the PubMed, Medline, e-Library databases; publications with clearly formulated conclusions; publications over the past 10 years. Criteria for excluding publications in the literary review: summaries, reports; articles with paid access; abstracts. A total of 82 sources were found, and 8 sources were included in the analysis.

Results: The analysis of the world literature made it possible to widely consider the possibility of performing reconstructive plastic surgery using visceral autografts at the stage of surgical treatment of patients with pharyngeal edema. At the same time, the literature describes significant reductions in the duration of rehabilitation and improvement of the quality of life of patients, as well as a decrease in the level of disability of operated patients.

Conclusion: Primary plasty of defects that occur after surgical treatment of laryngopharyngeal cancer, using local tissues, displaced and free flaps, is undoubtedly the most appropriate way to speed up the rehabilitation of patients and improve the quality of life in the shortest possible time.