Background: Following wide excision of cancers in the larynx and pharynx, there are two ways of reconstruction using free bowel transfers: (1) microvascular transfer of free jejunum flap for cervical esophagus with an accessory loop for voice reconstruction, (2) free ileocolon flap, with ascending colon for reconstruction of pharynx and cervical esophagus, and the segment of ileum for voice reconstruction. The swallowing function is more important to the patients°¦ survival, and should be carefully evaluated to find a guideline for the selection of different procedures.

Patients and Methods: From 1995 to 2002 forty patients of cancers in the larynx or pharynx were studied. After total pharyngolaryngectomy, 30 of them were reconstructed with the first method, and 10 were reconstructed with the second method. The cases selected did not have recurrence with the least follow-up time of 10 months. The swallowing function were evaluated by the following methods: (1) recording of diet nature, time for each meal and the progression in the postoperative training course, (2) weight gain, (3) esophageal transit scan using radionuclide, and (4) esophagogram.

Results: All patients were instructed to start oral intake at three weeks following reconstruction. All the patients of jejunum transfer can eat solid diet properly after training of swallowing for two weeks. However, in the colon group it takes one month of training on the average before they can take semisolid diet. Initially the colon group complain of food stasis in the neck after oral intake. This gradually disappear but the speed of eating is much slower than the group of jejunum transfer (42 minutes per meal in the colon group, compared to 28 minutes per meal in the jejunum group). Only 4 in the colon group can take solid diet eventually. Esophagogram showed patency of both groups except for one case of mild stricture at the junction of jejunum and thoracic esophagus.

Conclusions: The swallowing function is better in the jejunum group than the colon group. (Although the ileocolon transfer provides better satisfaction in voice function in another study of our patients.) However, if the resection of tumor is high up to the oropharynx, colon is still a reasonable option because of good size match between the oropharynx and colon.