Reconstruction of the pharynx and upper esophagus after resection for cancer.

Construction of a new gullet after circumferential resection of the pharynx and upper portion of the esophagus for cancer is a major challenge to the head and neck surgeon. Techniques for reconstruction use cervical skin, adjacent pedicle flaps, and interposed visceral segments. Each technique has its place; none is ideal or free from complication or failure. Cure rates are poor, and unsolved problems remain. The quest for the perfect technique must continue, but the ultimate solution rests not with reconstruction techniques but with earlier diagnosis and elimination of the need for reconstruction.