Reconstruction after salvage surgery for laryngo-pharyngo-esophageal tumors: The experience of the National Cancer Institute of Milan, Italy (1970–2010)

The Head and Neck Oncology Division (HNOD) of the National Cancer Institute of Milan (NCI), once equipped with 66 beds, operating rooms, and daily outpatient clinics, has been a leading center for elective and salvage surgery for head and neck tumors since the 1960s. Approximately 100 Italian and international physicians have attended the OCC to begin or further their studies in head and neck oncology.

Efficient reconstruction of the alimentary canal (primary or secondary) has been, and is, a significant challenge, often made more difficult by the patient's general (malnutrition, reduced immunocompetence, etc.) and local (reduced post-radiation healing capacity) conditions. In chronological order, but also with overlaps and pluralities, the fundamental stages in achieving this goal were: local grafts and flaps, the deltopectoral flap (Bakamjian, 1965), the tubulized gastric pull-up (Akiyama, 1978), the pectoralis major musculocutaneous flap (Ariyan, 1979), and free flaps (jejunal loop first described by Seidenberg in 1957).

A brief overview of the aforementioned techniques is provided, along with some technical details and precautions adopted by the HNOD.

This presentation aims to document a broad and consolidated path in pharyngolaryngoesophageal reconstruction after salvage surgery, a path that is largely historical but still relevant and evolving. Above all, the Authors propose it in memory of the Masters who traced this itinerary and of the Colleagues who shared it.