D.N. Akhmedin^1,2, A.M. Kukanova¹, A.T. Bekisheva^1,2, N.M. Dzhantemirova^1,2, M.S. Mauletbayev^1,2, A.K. Makishev^1,2

1. «Kazakh «Astana Medical University» Non-profit JSC, Astana, the Republic of Kazakhstan;
2. «Multidisciplinary Medical Center» SMI on the REM, Astana, the Republic of Kazakhstan

DOI: https://www.doi.org/10.52532/2521-6414-2024-1-71-51-56

UDC: 616.006.48:089.844

Year: 2024 issure: 71 number: 1 pages: 51-56

Download PDF:

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 assessment of 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.
Keywords: laryngopharyngeal cancer, reconstruction of the pharynx and cervical esophagus, visceral flap, fasciocutaneous flap, musculocutaneous flap.

List of sources used:

1. Кайдарова Д.Р., Шатковская О.В., Онгарбаев Б.Т., Сейсенбаева Г.Т., Ажмагамбетова А.Е., Жылкайдарова А.Ж., Лаврентьева И.К., Саги М.С. Показатели онкологической службы Республики Казахстан за 2022 год (статистические и аналитические материалы) / под ред. Д.Р. Кайдаровой. – Алматы: КазНИИОиР, 2023. – 434 с. [Kaidarova D.R., Shatkovskaya O.V., Ongarbaev B.T., Seisenbaeva G.T., Azhmagambetova A.E., Zhylkaydarova A.Zh., Lavrent’eva I.K., Sagi M.S. Pokazateli onkologicheskoj sluzhby Respubliki Kazaxstan za 2022 god (statisticheskie i analiticheskie materialy) / pod red. D.R. Kajdarovoj. – Almaty: KazNIIOiR, 2023. – 434 s. (in Russ/Kaz/En)]. https://onco.kz/wp-content/uploads/2023/09/pokazateli_2022_web.pdf
2. Петрова Г.В., Каприн А.Д., Старинский В.В., Грецова О.П. Заболеваемость злокачественными новообразованиями населения России // Онкология. Журнал им. П.А. Герцена. – 2014. – №3(5). – С. 5-10 [Petrova G.V., Kaprin A.D., Starinskij V.V., Grecova O.P. Zabolevaemost’ zlokachestvennymi novoobrazovaniyami naseleniya Rossii // Onkologiya. Zhurnal im. P.A. Gercena. – 2014. – №3(5). – S. 5-10 (In Russ.)]. https://www.mediasphera.ru/issues/onkologiya-zhurnal-im-p-a-gertsena/2014/5/522305-218X2015051?lang=ru
3. Чижевская С.Ю. Современные подходы повышения эффективности комбинированного лечения и оценка качества жизни больных раком гортани и гортаноглотки: Автореф. дис. … док. мед. наук: 14.01.12. – Томск: ФГБУ «Научно-исследовательский институт онкологии» СО РАМН, 2013. – 47 с. [Chizhevskaya S.Yu. Sovremennye podxody povysheniya e’ffektivnosti kombinirovannogo lecheniya i ocenka kachestva zhizni bol’nyx rakom gortani i gortanoglotki: Avtoref. dis. … dok. med. nauk: 14.01.12. – Tomsk: FGBU «Nauchno-issledovatel’skij institut onkologii» SO RAMN, 2013. – 47 s. (in Russ.)]. https://medical-diss.com/medicina/sovremennye-podhody-povysheniya-effektivnosti-kombinirovannogo-lecheniya-i-otsenka-kachestva-zhizni-bolnyh-rakom-gortani-
4. Гордон К.Б., Гулидов И.А., Семёнов А.В., Раджапова М.У., Севрюков Ф.Е. Ранние результаты лучевой терапии местнораспространённого рака органов головы и шеи в режиме ускоренного фракционирования // Радиация и риск (Бюллетень НРЭР). – 2018. – №27(2). – C. 107-116 [Gordon K.B., Gulidov I.A., Semyonov A.V., Radzhapova M.U., Sevryukov F.E. Rannie rezul’taty luchevoj terapii mestnorasprostranyonnogo raka organov golovy i shei v rezhime uskorennogo frakcionirovaniya // Radiaciya i risk (Byulleten’ NRE’R). – 2018. – №27(2). – C. 107-116 (in Russ.)]. https://doi.org/10.21870/0131-3878-2018-27-2-107-116
5. Каприн А.Д., Решетов И.В., Ратушный М.В., Кравцов С.А., Поляков А.П., Маторин О.В., Севрюков Ф.Е., Филюшин М.М., Васильев В.Н., Ребрикова И.В. Микрохирургическая реконструкция тканей головы и шеи висцеральными аутотрансплантатами, сформированными из мини-доступа // Опухоли головы и шеи. – 2015. – №2. – С. 14-19 [Kaprin A.D., Reshetov I.V., Ratushnyj M.V., Kravcov S.A., Polyakov A.P., Matorin O.V., Sevryukov F.E., Filyushin M.M., Vasil’ev V.N., Rebrikova I.V. Mikroxirurgicheskaya rekonstrukciya tkanej golovy i shei visceral’nymi autotransplantatami, sformirovannymi iz mini-dostupa // Opuxoli golovy i shei. – 2015. – №2. – S. 14-19 (in Russ.)]. https://doi.org/10.17650/2222-1468-2015-5-2-14-19
6. Ратушный М.В., Поляков А.П., Сидоров Д.В., Троицкий А.А., Маторин О.В., Севрюков Ф.Е., Филюшин М.М. Микрохирургическая реконструкция аэродигестивного тракта толстокишечно-подвздошным аутотрансплантатом у больного раком гортаноглотки // Онкология. Журнал им. П.А. Герцена. – 2014. –№4. – С. 34-42 [Ratushnyj M.V., Polyakov A.P., Sidorov D.V., Troickij A.A., Matorin O.V., Sevryukov F.E., Filyushin M.M. Mikroxirurgicheskaya rekonstrukciya ae’rodigestivnogo trakta tolstokishechno-podvzdoshnym autotransplantatom u bol’nogo rakom gortanoglotki // Onkologiya. Zhurnal im. P.A. Gercena. – 2014. – №4. – S. 34-42  (in Russ.)]. https://cyberleninka.ru/article/n/mikrohirurgicheskaya-rekonstruktsiya-aerodigestivnogo-trakta-tolstokishechno-podvzdoshnym-autotransplantatom-u-bolnogo-rakom
7. Ратушный М.В., Решетов И.В., Поляков А.П., Кравцов С.А., Ребрикова И.В., Бабаскина Н.В. Реконструктивные операции на глотке у онкологических больных // Онкология. Журнал им. П.А. Герцена. – 2015. №4(4). – С. 57-63 [Ratushnyj M.V., Reshetov I.V., Polyakov A.P., Kravcov S.A., Rebrikova I.V., Babaskina N.V. Rekonstruktivnye operacii na glotke u onkologicheskix bol’nyx // Onkologiya. Zhurnal im. P.A. Gercena. – 2015. №4(4). – S. 57-63 (in Russ.)]. https://doi.org/10.17116/onkolog20154457-63
8. Остринская Т.В., Жуманкулов А.М., Анисимова А.В. Реконструкция постоперационных дефектов при опухолях гортаноглотки и шейного отдела пищевода // Опухоли головы и шеи. – 2017. – №7(3). – С. 39-46 [Ostrinskaya T.V., Zhumankulov A.M., Anisimova A.V. Rekonstrukciya postoperacionnyx defektov pri opuxolyax gortanoglotki i shejnogo otdela pishhevoda // Opuxoli golovy i shei. – 2017. – №7(3). – S. 39-46 (in Russ.)]. https://doi.org/10.17650/2222-1468-2017-7-3-39-46
9. Артемьев С.С., Раджабова З.А., Нажмудинов Р.А., Котов М.А., Артемьева Е.В., Раджабова М.А. Результаты лечения пациентов с местнораспространенным раком орофарингеальной области // Мед. Алфавит. – 2020. – №20. – С. 46-48 [Artem’ev S.S., Radzhabova Z.A., Nazhmudinov R.A., Kotov M.A., Artem’eva E.V., Radzhabova M.A. Rezul’taty lecheniya pacientov s mestnorasprostranennym rakom orofaringeal’noj oblasti // Med. Alfavit. – 2020. – №20. – S. 46-48 (in Russ.)].https://doi.org/10.33667/2078-5631-2020-20-46-48
10. Ходорковский М. А., Петров Б. В., Скорынин О.С., Ходорковский М. М. Вторичные реконструкции при пострезекционных дефектах тканей головы и шеи // Голова и шея. – 2015. – Vol. 3. – С. 59. [Xodorkovskij M.A., Petrov B.V., Skorynin O.S., Xodorkovskij M.M. Vyorichnyje rekonstrukcii pri postresektsionnyx defektax tkanej golovy i shei // Golova i sheja. – 2015. – Vol. 3. – S. 59 (in Russ.)]. https://hnj.science/wp-content/uploads/2020/08/3-2015-1.pdf
11. Anthony J.P., Singer M.I., Mathes S.J. Pharyngoesophageal reconstruction using the tubed free radial forearm flap // Clin. Plast. Surg. – 1994. – Vol. 21. – P. 137-147. https://pubmed.ncbi.nlm.nih.gov/8112007/
12. Chew K.Y., Kok Y.O., Ong W.L., Tan B.K. Coverage of anterior mediastinal tracheostomy with bipedicled anterolateral thigh flap // JPRAS Open. – 2021. – Vol. 28. – P. 4-9. https://doi.org/10.1016/j.jpra.2021.01.007
13. Gasteratos K., Vlachopoulos N., Kokosis G., Goverman J. Efficacy and Safety of Microsurgical Pharyngolaryngeal and Pharyngoesophageal Reconstruction: A Systematic Review of the Literature // Plast. Reconstr. Surg. Glob. Open. – 2023. – Vol. 11(4). – P. 4958. https://doi.org/10.1097/GOX.0000000000004958
14. Kumar V., Kalwani R., Bindu A., Mathews S., Mantri M., Jaiswal D., Shankhdhar V.K. Comparison of Functional Outcomes of Intestinal Flaps Vs Tubed Fasciocutaneous Flaps for Circumferential Pharyngoesophageal Defects-an Indian Perspective // Indian J. Surg. Oncol. – 2023. – Vol. 14(3). – P. 668-676. https://doi.org/10.1007/s13193-023-01723-x
15. Balasubramanian D., Subramaniam N., Rathod P., Murthy S., Sharma M., Mathew J., Thankappan K., Iyer S. Outcomes following pharyngeal reconstruction in total laryngectomy – Institutional experience and review of literature // Indian J. Plast. Surg. – 2018. – Vol. 51(2). – P. 190-195. https://doi.org/10.4103/ijps.IJPS_79_17
16. Razdan S.N., Albornoz C.R., Matros E., Paty P.B., Cordeiro P.G. Free Jejunal Flap for Pharyngoesophageal Reconstruction in Head and Neck Cancer Patients: An Evaluation of Donor-Site Complications // J. Reconstr. Microsurg. – 2015. – Vol. 31(9). – P. 643-6. https://doi.org/10.1055/s-0035-1556872
17. Marra C., Pinto V., Benanti E., De Maria F., Pinelli M., Spaggiari A., De Santis G. Radial forearm flap versus antero-lateral thigh flap in oral soft tissue reconstruction: update and statistical analysis on our 77 consecutive cases for an objective selection criteria // Acta Biomed. – 2023. – Vol. 94(5). – P. 2023252. https://doi.org/10.23750/abm.v94i5.15174
18. Escandón J.M., Santamaría E., Prieto P.A., Duarte-Bateman D., Ciudad P., Pencek M., Langstein H.N., Chen H.C., Manrique O.J. Reconstruction of Pharyngolaryngeal Defects with the Ileocolon Free Flap: A Comprehensive Review and How to Optimize Outcomes // Arch. Plast. Surg. – 2022. – Vol. 49(3). – P. 378-396. https://doi.org/10.1055/s-0042-1748652
19. Hanubal K.S., Chheda N.N., Dziegielewski P.T. Neopharyngeal Stricture following Laryngectomy // Semin. Plast. Surg. – 2022. – Vol. 37(1). – P. 31-38. https://doi.org/10.1055/s-0042-1759796