Comparison of Anterolateral Thigh Flap and Free Jejunal Transfer Based on Patient‐ and Defect‐Based Selection for Circumferential Pharyngoesophageal Reconstruction

BACKGROUND: This study compared surgical and functional outcomes between anterolateral thigh (ALT) flap and free jejunal transfer (FJ) reconstruction after pharyngolaryngoesophagectomy. METHODS: We retrospectively reviewed 53 patients undergoing pharyngolaryngoesophagectomy with immediate reconstruction: 33 with ALT and 20 with FJ. Surgical and functional outcomes and postoperative CT findings were compared. RESULTS: FJ was preferentially selected for caudally extended defects requiring deep esophageal anastomosis, whereas ALT was mainly used for cranial defects. Surgical outcomes, dietary status, and hospital stay were comparable. Anastomotic stricture occurred in 1 ALT patient (3%) and 2 FJ patients (10%). ALT conduits were more frequently lateral to the trachea on CT (70% vs. 45%), with comparable dietary status. Speech acquisition was higher with ALT. CONCLUSIONS: Patient- and defect-based selection achieved comparable outcomes with low stricture rates. ALT is a laparotomy-free option for selected patients, whereas FJ may be preferable for caudally extended defects requiring deep mediastinal anastomosis.