Immediate reconstruction of pharyngoesophageal defects. Preference or reference.

In this era of development in reconstruction, interest in searching for the most appropriate procedure for replacing the pharyngoesophageal defect is intense. The type of defect, depending on the level of invasion by the cancer, should be classified as partial pharyngeal, circumferential pharyngeal, or pharyngoesophageal. Within each class, the surgeon can have his preference for a reconstructive procedure according to available expertise and familiarity. In our series of 97 patients with pharyngoesophageal defects resulting from resection of laryngeal, hypopharyngeal, and cervical esophageal cancers, the patch-on pectoralis major myocutaneous flap, the tubed pectoralis major myocutaneous flap, and the stomach were used for the three types of defects, respectively. Mortality and morbidity, while kept at an acceptable level, appear to rise as the complexity of the procedure increases. This supports the argument that the reconstructive method should be selected with reference to the type of defect, which is in turn dependent on the site and behavior of the tumor. The reconstructive procedure is to fit the defect, and not vice versa.