Ileocecal intestine as an alternative material for restoration of esophageal and vocal functions in cancer patients after laryngectomy (literature review)
https://doi.org/10.17650/2222-1468-2025-15-1-47-55
Abstract
The ileocolon flap is a promising plastic material for one-stage restoration of the nutrition and voice functions in cancer patients after laryngectomy and laryngopharyngectomy. The advantage of using this flap over alternative visceral flaps is its anatomical and functional features, the presence of its own one-way valve that assists in the passage of air from the trachea to the pharynx, prevents regurgitation of food or saliva into the respiratory tract and thereby ensures the restoration of vocal function without the need for additional devices. This review analyzes the use of ileocolon flap in the reconstruction of the upper aerodigestive tract, its advantages over other methods, as well as thе role of this approach in improving the quality of life of patients. Historical aspects, technical features, factors influencing the choice of technique, and the results of clinical studies confirming the effectiveness and reliability of this reconstruction method are considered.
Keywords
About the Authors
A. M. SvirnovskayaRussian Federation
Anastasia Maksimovna Svirnovskaya
3 2nd Botkinsky Proezd, Moscow 125284
M. V. Ratushniy
Russian Federation
3 2nd Botkinsky Proezd, Moscow 125284
A. Р. Polyakov
Russian Federation
3 2nd Botkinsky Proezd, Moscow 125284
References
1. The state of cancer care in Russia in 2923. Ed. by A.D. Kaprin, V.V. Starinsky, A.O. Shakhzadova. Moscow: MNIOI im. P.A. Gertsena – filial FGBU “NMITS radiologii” Minzdrava Rossii, 2024. 262 p. (In Russ.).
2. Malignant neoplasms in Russia, 2023 (morbidity and mortality). Ed. by A.D. Kaprin, V.V. Starinsky, A.O. Shakhzadova. Moscow: MNIOI im. P.A. Gertsena – filial FGBU “NMITS radiologii” Minzdrava Rossii, 2024. 276 p. (In Russ.).
3. Peracchia A., Bardini R., Ruol A. et al. Surgical management of carcinoma of the hypopharynx and cervical esophagus. Hepatogastroenterology 1990;37(4):371–5.
4. McCarthy C.M., Kraus D.H., Cordeiro P.G. Tracheostomal and cervical esophageal reconstruction with combined deltopectoral flap and microvascular free jejunal transfer after central neck exentration. Plast Reconstr Surg 2005;115(5):1304–10. DOI: 10.3390/ijerph17124605
5. Reshetov I.V. Reconstructive and plastic surgery of tumors of the head and neck. Prakticheskaya onkologiya = Practical Oncology 2003;4(1):9–14. (In Russ.).
6. Stein D.M., Schuller D.E. Advantages of pectoralis myocutaneous flap pharyngeal reconstruction. Laryngoscope 1989;99(7 Pt 1): 691–6. DOI: 10.1288/00005537-198907000-00005
7. Ostrinskaya T.V., Zhumankulov A.M., Anisimova A.V. Reconstruction of postoperative defects in tumors of the laryngopharynx and cervical esophagus. Opukholi golovy i shei = Head and Neck Tumors 2017;7(3):39–46. (In Russ.).
8. Seidenberg B., Rosenak S.S., Hurwitt E.S., Som M.L. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Ann Surg 1959;149(2):162–71. DOI: 10.1097/00000658-195902000-00002
9. Hanson R.P., Chow T.K., Feehan E. et al. Analysis of functional results and quality of life following free jejunal flaps for reconstruction after upper aerodigestive neoplastic resection: the St James’s experience. JPRAS 2007;60(6):577–82. DOI: 10.1016/j.bjps.2006.11.012
10. Koh H.K., Tan N.C., Tan B.K., Ooi A.S.H. Comparison of outcomes of fasciocutaneous free flaps and jejunal free flaps in pharyngolaryngoesophageal reconstruction. Ann Plast Surg 2019;82(6):646–52. DOI: 10.1097/SAP.0000000000001776
11. Bouhadana G., Azzi A.J., Gilardin, M.S. The ideal flap for reconstruction of circumferential pharyngeal defects: A systematic review and meta-analysis of surgical outcomes. J Plast Reconstr Aesthet Surg 2021;74(8):1779–90. DOI: 10.1016/j.bjps.2021.03.042
12. Elaldi R., Gorphe P., Kolb F. et al. Swallowing outcomes over time after total pharyngolaryngectomy and free flap reconstruction. J Plast Reconstr Aesthet Surg 2023;82:21–6. DOI: 10.1016/j.bjps.2023.04.006
13. Reynaud A.A.M. Observation sur une fistule aérienne, avec occlusion complètte de la partienférieure du larynx, pour servir à l’histoire de la phonation. Gaz méd Paris 1841;9:583–5.
14. Mozolewski E. Surgical rehabilitation of voice and speech following laryngectomy. Otolaryngol Pol 1972;26(6):653–61. (In Polish).
15. Hancock K., Houghton B., Van As-Brooks C. J., Coman W. First clinical experience with a new non-indwelling voice prosthesis (Provox® NID™) for voice rehabilitation after total laryngectomy. Acta Oto-Laryngologica 2005;125(9):981–90. DOI: 10.1080/00016480510043486
16. Hilgers F.J., Ackerstaff A.H., Jacobi I. et al. Prospective clinical phase II study of two new indwelling voice prostheses (Provox Vega 22.5 and 20 Fr) and a novel anterograde insertion device (Provox Smart Inserter). Laryngoscope 2010;120(6):1135–43. DOI: 10.1002/lary.20925
17. Schuldt T., Ovari A., Dommerich S. The costs for different voice prostheses depending on the lifetime. Laryngorhinootologie 2013;92(6):389–93. DOI: 10.1055/s-0033-1337951
18. Graville D., Gross N., Andersen P. et al. The long-term indwelling tracheoesophageal prosthesis for alaryngeal voice rehabilitation. Arch Otolaryngol Head Neck Surg 1999;125(3):288–92. DOI: 10.1001/archotol.125.3.288
19. Vlantis A.C., Gregor R.T., Elliot H., Oudes M. Conversion from a non-indwelling to a Provox2 indwelling voice prosthesis for speech rehabilitation: Comparison of voice quality and patient preference. J Laryngol Otol 2003;117(10):815–20. DOI: 10.1258/002221503770716278
20. Maniaci A., La Mantia I., Mayo-Yóñez M. et al. Vocal rehabilitation and quality of life after total laryngectomy: state-of-the-art and systematic review. Prosthesis 2023;5(3):587–601. DOI: 10.3390/prosthesis5030041
21. Cocuzza S., Maniaci A., Grillo C. et al. Voice-related quality of life in post-laryngectomy rehabilitation: tracheoesophageal fistula’s wellness. Int J Environ Res Public Health 2020;17(12):4605. DOI: 10.3390/ijerph17124605
22. Molteni G., Fulco J., Gazzini L. et al. Prosthetic voice rehabilitation after laryngoesophagectomy: surgical and functional outcomes. Eur Arch Otorhinolaryngol 2022;279(8):4085–92. DOI: 10.1007/s00405-022-07251-8
23. Giordano L., Toma S., Teggi R. et al. Satisfaction and quality of life in laryngectomees after voice prosthesis rehabilitation. Folia Phoniatr Logop 2011;63(5):231–6. DOI: 10.1159/000323185
24. Galli A., Giordano L., Biafora M. et al. Voice prosthesis rehabilitation after total laryngectomy: are satisfaction and quality of life maintained over time? Acta Otorhinolaryngol Ital 2019;39(3):162–8. DOI: 10.14639/0392-100X-2227
25. Escandón J.M., Santamaría E., Prieto P.A. et al. Reconstruction of pharyngolaryngeal defects with the ileocolon free flap: a comprehensive review and how to optimize outcomes. Arch Plast Surg 2022;49(3):378–96. DOI: 10.1055/s-0042-1748652
26. Kawahara H., Shiraishi T., Yasugawa H. et al. A new surgical technique for voice restoration after laryngopharyngoesophagectomy with a free ileocolic graft: preliminary report. Surgery 1992;111(5):569–75.
27. Sartoris A., Succo G., Mioli P., Merlino G. Reconstruction of the pharynx and cervical esophagus using ileocolic free autograft. Am J Surg 1999;178(04):316–22. DOI: 10.1016/s0002-9610(99)00177-4
28. Succo G., Mioli P., Merlino G., Sartoris A. New options for aerodigestive tract replacement after extended pharyngolaryngectomy. Laryngoscope 2000;110(10 Pt 1):1750–5. DOI: 10.1097/00005537-200010000-00036
29. Kobayashi M., Onozuka N., Fukuda A. et al. New surgical technique for primary and secondary voice restoration using a free ileocecal patch graft after total laryngectomy. Surg Today 2003;33(11):817–22. DOI: 10.1007/s00595-003-2616-1
30. Chen H.C., Ciudad P., Chen S.H., Agko M. Thirty-five years of single surgeon experience in the reconstruction of esophagus and voice with free ileocolon flap following total pharyngolaryngectomy. J Surg Oncol 2018;117(3):459–68. DOI: 10.1002/jso.24864
31. Amendola F., Chen S.H., Chen H.C. Voice tube shortening in voice reconstruction with ileo-colon FLAP: technical tips for a safe revision and improvement of voice quality. J Plast Reconstr Aesthet Surg 2021;74(6):1355–401. DOI: 10.1016/j.bjps.2020.12.038
32. Lo Torto F., Manrique O.J., Ciudad P. et al. Pearls and pitfalls of voice reconstruction after pharyngolaryngectomy using the ileocolon free flap. Microsurgery 2017;37(5):453–4. DOI: 10.1002/micr.30059
33. Lo Torto F., Ribuffo D., Manrique O.J. et al. Simultaneous restoration of swallowing and voice function with ileocolon free flap. J Craniofac Surg 2020;31(4):916–8. DOI: 10.1097/SCS.0000000000006274
34. Lin K.K., Chen H.C., Chen S.H. Comparison of ileocolon flap and jejunum flap for voice reconstruction. Microsurgery 2023;43(4):420–1. DOI: 10.1002/micr.31049
35. Chen H.C., Patel H., Chen Y.C. et al. Talking jejunum: a new, safe technique for voice reconstruction using free-jejunum transfer. Plast Reconstr Surg 2003;111(1):336–40. DOI: 10.1097/01.PRS.0000035715.63041.2F
Review
For citations:
Svirnovskaya A.M., Ratushniy M.V., Polyakov A.Р. Ileocecal intestine as an alternative material for restoration of esophageal and vocal functions in cancer patients after laryngectomy (literature review). Head and Neck Tumors (HNT). 2025;15(1):47-55. (In Russ.) https://doi.org/10.17650/2222-1468-2025-15-1-47-55