A rare reconstruction procedure was performed in pharyngeal region with a free jejunal flap
Hubli, 27th July 2022: Doctors at HCG NMR Cancer Centre Hubli successfully performed a rare reconstruction surgery of the pharyngeal region with a free jejunal flap on a 46-year-old patient Mrs Vanita suffering from throat cancer. She was facing difficulties in swallowing food due to this condition.
The patient had consulted a hospital in Belgaum and was later referred to HCG NMR Cancer Centre Hubli. Upon her initial examination at HCG, it was revealed that she was suffering from Stage 1 of hypopharynx carcinoma (bottom part of the throat).
Analysing her condition, the team of specialists in oncology at HCG NMR, Hubli decided to give definitive chemo radiotherapy and the patient received the complete course of chemoradiotherapy.
Post the treatment, the patient was asked to undergo a PET CT scan after 3 months to evaluate the condition of the tumour. In about 90% of the cases the tumour gradually dissolves but unfortunately in Vanita’s case the PET CT scan revealed that the tumour had spread to the back wall of the swallowing passage affecting the pharynx, larynx, and the voice box. Analysing the seriousness of the condition, Dr. Rudresh Tabali, Consultant Surgical Oncologist and team decided to perform Total Laryngopharyngectomy, a procedure involving the removal of the voice box and a portion of the affected pharyngeal region. During the procedure, the affected areas pharynx and larynx were removed, which resulted in removal of her voice box, as there were no supporting tissues to hold it in place. The tumour had also spread to the lymph nodes affecting both sides of the neck for which a Bilateral Neck node dissection was performed, a surgical procedure to remove the lymph nodes.
Post removal of the tumour-affected regions, the expert team of plastic surgeons involving Dr. Kishore Ballary and Dr. Arun Jeedi along with Dr Rudresh Tabali performed a pharynx re-construction surgery with jejunal-free flap called Microvascular Anastomosis. This is a surgical procedure used to join the harvested jejunum vessels to the vessels of the neck, thereby restoring blood supply to jejunal flap. This was accomplished by removing an area of the tissue in the jejunum and surgically replacing it in the affected area of the pharyngeal region.
Speaking about the complex procedure Dr. Rudresh Tabali, Consultant-Surgical Oncology, HCG NMR Cancer Hospital Hubli said, “Performing a complex salvage procedure following Chemoradiotherapy is always challenging to surgeon in terms of resection and reconstruction. This was a challenging case as the tumour had spread to the back wall of the swallowing passage affecting the major areas like the pharynx, larynx, and the voice box. Initially, a pharynx reconstructive procedure was performed to remove residual cancer that had affected the pharyngeal region of the patient. Generally, in such cases the oesophagus is removed, and the stomach is made to act as the food pipe. But, under this technique jejunal-free flap was inserted which not only enables the patient to eat normally, but also doesn’t interfere with the storage and functioning of the digestive tract. Vanitha will now be able to sleep on flat bed, eat or swallow food in regular quantity unlike with stomach tube and recover faster. This is first time in North Karnataka we did successful free jejunal flap for pharyngeal reconstruction. Now patient is fine able to take normal food through mouth. Post resection histopathology report revealed complete cancer clearance.”
Dr. Jaikishan, Chief Operating Officer, HCG NMR Cancer Centre Hubli said, “HCG NMR Cancer Centre has been a pioneer in offering the best-in-class treatment to patients. We strive to provide quality treatment to patients in and around Hubli. This is a complex procedure, and I would want to congratulate the entire team for performing this rare reconstructive procedure”.
Rajendra, Patient’s husband said “We as a family are happy that my wife got world best treatment available for this potentially fatal disease. On hearing about her condition for the first time, we were worried and confused. Dr. Rudresh Tabali assured me of the best treatment options and removal of the tumour and restoration of food passage. I am delighted and have no words to express my gratitude to the doctors and the entire team at HCG NMR Cancer Centre for giving Vanita a second chance to live again”.