Functional outcomes of upper aerodigestive tract reconstruction using visceral autografts in oncology patients

Introduction. Extended surgeries for laryngeal and hypopharyngeal tumors are accompanied by the loss of alimentary and vocal functions. Therefore, the efficacy of upper aerodigestive tract reconstruction must be evaluated not only by structural integrity but also by functional outcomes.

Aim. To evaluate the functional outcomes of upper aerodigestive tract reconstruction using visceral autografts in oncology patients and to determine the clinical features of utilizing the ileoascendocecal segment without a voice prosthesis and a small bowel autograft combined with tracheoesophageal puncture and voice prosthodontics.

Materials and methods. The treatment outcomes of 35 patients following laryngectomy with hypopharyngeal resection were analyzed. In 17 cases, reconstruction was performed using an ileoascendocecal segment; in 18 cases, a small bowel autograft with voice prosthesis placement was used. The evaluation included alimentary function, clinical and acoustic parameters of alaryngeal voice, voice prosthesis functioning, quality of life assessed by the Voice Handicap Index-30 (VHI-30) questionnaire, and the nature of postoperative complications.

Results. Satisfactory patency of the reconstructed segment was noted in 14 out of 15 patients in the ileoascendocecal segment group and in 16 out of 18 patients in the small bowel autograft group. Swallowing outcomes in both groups were good or excellent. Quantitative variables are presented as median (Me) and interquartile range [Q₁; Q₃]. The majority of acoustic parameters showed no statistically significant differences; however, the maximum phonation time was longer in patients who underwent reconstruction with the ileoascendocecal segment: 4.60 [4.22; 5.53] s versus 4.02 [3.41; 4.70] s. The total VHI-30 score was lower in the ileoascendocecal segment group: 25 [18; 32] points versus 38 [29; 47] points, indicating less voice-related disability. Following visceral reconstruction, the most common complications included cervical anastomotic fistulas and complications associated with voice prosthesis functioning.

Conclusion. Both methods – the use of an ileoascendocecal segment and a small bowel autograft with voice prosthodontics – provide effective restoration of alimentary function but differ in the mechanism of vocal rehabilitation, dependence on a voice prosthesis, and the clinical profile of complications.