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Functional and Radiological Evaluation of Free Jejunal Transplant Reconstructions After Radical Resection of Hypopharyngeal or Proximal Esophageal Cancer

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Abstract

Cancer of the pharyngoesophageal junction (PEJ) is associated with late onset of symptoms, high morbidity, and a dismal prognosis. Radical surgery with pharyngolaryngectomy and reconstruction with a free vascularized jejunal transplant has been increasingly practiced in the treatment of these patients. This strategy is not devoid of challenges, and the present study is aimed at evaluating the long-term functional outcome among patients who have undergone such surgical treatment. Ten patients (mean age 59 years) with a mean follow-up time of 54 months were included. Clinical assessment, health-related quality of life (HRQL) questionnaires, and a standardized radiography examination were used for evaluation. The Karnofsky index ranged from 60 to 90 (mean 82). Global QL scores (EORTC QLQ-C30) had a mean value of 74, and the mean scores for dysphagia-related items of the EORTC QLQ OES-18 questionnaire were within the lower range. Radiographic signs of disturbed bolus transport through the jejunal transplant were found in all patients examined despite the grading of dysphagia from 0 to 1. The Watson dysphagia score varied between 0.5 and 45.0 (mean 16.2). No correlations were found between radiographic findings and the clinical evaluations or the outcomes assessed by the HRQL questionnaires. HRQL was found to be generally good after cancer of the PEJ and jejunal transplant insertion. Most patients reported mild dysphagia. Radiologic signs of disturbed bolus passage were common, but their clinical impact seemed questionable.

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References

  1. Talback M, Rosen M, Stenbeck M, et al. (2004) Cancer patient survival in Sweden at the beginning of the third millennium—predictions using period analysis. Cancer Causes Control 15:967–976

    PubMed  Google Scholar 

  2. Tytgat GN, Bartelink H, Bernards R, et al. (2004) Cancer of the esophagus and gastric cardia: recent advances. Dis Esophagus 17:10–26

    Article  PubMed  CAS  Google Scholar 

  3. Mariette C, Triboulet JP (2006) Which treatment for squamous cell carcinoma of the pharyngoesophageal junction? J Surg Oncol 94:175–177

    Article  PubMed  CAS  Google Scholar 

  4. Bergquist H, Ejnell H, Fogdestam I, et al. (2004) Functional long-term outcome of a free jejunal transplant reconstruction following chemoradiotherapy and radical resection for hypopharyngeal and proximal oesophageal carcinoma. Dig Surg 21:426–431; discussion 432–423

    Article  PubMed  Google Scholar 

  5. Triboulet JP, Mariette C, Chevalier D, et al. (2001) Surgical management of carcinoma of the hypopharynx and cervical esophagus: analysis of 209 cases. Arch Surg 136:1164–1170

    Article  PubMed  CAS  Google Scholar 

  6. Mendenhall WM, Sombeck MD, Parsons JT, et al. (1994) Management of cervical esophageal carcinoma. Semin Radiat Oncol 4:179–191

    Article  PubMed  Google Scholar 

  7. Stuschke M, Stahl M, Wilke H, et al. (1999) Induction chemotherapy followed by concurrent chemotherapy and high-dose radiotherapy for locally advanced squamous cell carcinoma of the cervical oesophagus. Oncology 57:99–105

    Article  PubMed  CAS  Google Scholar 

  8. Kornfehl J (1994) Autotransplanted jejunum in head and neck cancer. Eur J Cancer B Oral Oncol 30B:16–22

    Article  PubMed  CAS  Google Scholar 

  9. Jones AS, Roland NJ, Husband D, et al. (1996) Free revascularized jejunal loop repair following total pharyngolaryngectomy for carcinoma of the hypopharynx: report of 90 patients. Br J Surg 83:1279–1273

    Article  PubMed  CAS  Google Scholar 

  10. Schilling MK, Eichenberger M, Maurer CA, et al. (2002) Long-term survival of patients with stage IV hypopharyngeal cancer: impact of fundus rotation gastroplasty. World J Surg 26:561–565

    Article  PubMed  Google Scholar 

  11. Nakatsuka T, Harii K, Asato H, et al. (1998) Comparative evaluation in pharyngo-oesophageal reconstruction: radial forearm flap compared with jejunal flap: a 10-year experience. Scand J Plast Reconstr Surg Hand Surg 32:307–310

    Article  PubMed  CAS  Google Scholar 

  12. Morshed K, Szymanski M, Golabek W (2005) Reconstruction of the hypopharynx with U-shaped pectoralis major myocutaneous flap after total pharyngo-laryngectomy. Eur Arch Otorhinolaryngol 262:259–262

    Article  PubMed  Google Scholar 

  13. Ullah R, Bailie N, Kinsella J, et al. (2002) Pharyngo-laryngo-oesophagectomy and gastric pull-up for post-cricoid and cervical oesophageal squamous cell carcinoma. J Laryngol Otol 116:826–830

    Article  PubMed  CAS  Google Scholar 

  14. Oniscu GC, Walker WS, Sanderson R (2001) Functional results following pharyngolaryngooesophagectomy with free jejunal graft reconstruction. Eur J Cardiothorac Surg 19:406–410

    Article  PubMed  CAS  Google Scholar 

  15. Shirakawa Y, Naomoto Y, Noma K, et al. (2004) Free jejunal graft for hypopharyngeal and esophageal reconstruction. Langenbecks Arch Surg 389:387–390

    Article  PubMed  Google Scholar 

  16. Higo R, Tayama N, Nito T (2004) Longitudinal analysis of progression of dysphagia in amyotrophic lateral sclerosis. Auris Nasus Larynx 31:247–254

    Article  PubMed  Google Scholar 

  17. Kostic S, Andersson M, Hellstrom M, et al. (2005) Timed barium esophagogram in the assessment of patients with achalasia: reproducibility and observer variation. Dis Esophagus 18:96–103

    Article  PubMed  CAS  Google Scholar 

  18. Schag CC, Heinrich RL, Ganz PA (1984) Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol 2:187–193

    PubMed  CAS  Google Scholar 

  19. Ogilvie AL, Dronfield MW, Ferguson R, et al. (1982) Palliative intubation of oesophagogastric neoplasms at fibreoptic endoscopy. Gut 23:1060–1067

    PubMed  CAS  Google Scholar 

  20. Dakkak M, Bennett JR (1992) A new dysphagia score with objective validation. J Clin Gastroenterol 14:99–100

    Article  PubMed  CAS  Google Scholar 

  21. Aaronson NK, Ahmedzai S, Bergman B, et al. (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376

    Article  PubMed  CAS  Google Scholar 

  22. Blazeby JM, Conroy T, Hammerlid E, et al. (2003) Clinical and psychometric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer. Eur J Cancer 39:1384–1394

    Article  PubMed  CAS  Google Scholar 

  23. Hamlet SL, Muz J, Patterson R, et al. (1989) Pharyngeal transit time: assessment with videofluoroscopic and scintigraphic techniques. Dysphagia 4:4–7

    Article  PubMed  CAS  Google Scholar 

  24. Kundel HL, Polansky M (2003) Measurement of observer agreement. Radiology 228:303–308

    Article  PubMed  Google Scholar 

  25. Benazzo M, Bertino G, Lanza L, et al. (2001) Voice restoration after circumferential pharyngolaryngectomy with free jejunum repair. Eur Arch Otorhinolaryngol 258:173–176

    Article  PubMed  CAS  Google Scholar 

  26. Michelson H, Bolund C, Nilsson B, et al. (2000) Health-related quality of life measured by the EORTC QLQ-C30—reference values from a large sample of Swedish population. Acta Oncol 39:477–484

    Article  PubMed  CAS  Google Scholar 

  27. Lewin JS, Barringer DA, May AH, et al. (2005) Functional outcomes after circumferential pharyngoesophageal reconstruction. Laryngoscope 115:1266–1271

    Article  PubMed  Google Scholar 

  28. Kostic S, Kjellin A, Ruth M, et al. (2007) Pneumatic dilatation or laparoscopic cardiomyotomy in the management of newly diagnosed idiopathic achalasia: results of a randomized controlled trial. World J Surg 31:470–478

    Article  PubMed  CAS  Google Scholar 

  29. Viklund P, Wengstrom Y, Rouvelas I, et al. (2006) Quality of life and persisting symptoms after oesophageal cancer surgery. Eur J Cancer 42:1407–1414

    Article  PubMed  Google Scholar 

  30. Prakash C, Clouse RE (2002) Esophageal motor disorders. Curr Opin Gastroenterol 18:454–463

    Article  PubMed  Google Scholar 

  31. Okazaki M, Asato H, Sarukawa S, et al. (2005) A revised method for pharyngoesophageal reconstruction using free jejunal transfer. Ann Plast Surg 55:643–647

    Article  PubMed  CAS  Google Scholar 

  32. Ahmad I, Kumar BN, Radford K, et al. (2000) Surgical voice restoration following ablative surgery for laryngeal and hypopharyngeal carcinoma. J Laryngol Otol 114:522–525

    Article  PubMed  CAS  Google Scholar 

  33. McAuliffe MJ, Ward EC, Bassett L, et al. (2000) Functional speech outcomes after laryngectomy and pharyngolaryngectomy. Arch Otolaryngol Head Neck Surg 126:705–709

    PubMed  CAS  Google Scholar 

  34. Koh P, Turnbull G, Attia E, et al. (2004) Functional assessment of the cervical esophagus after gastric transposition and cervical esophagogastrostomy. Eur J Cardiothorac Surg 25:480–485

    Article  PubMed  Google Scholar 

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Acknowledgments

Henrik Bergquist and Mats Andersson contributed equally to the completion of this report. We thank speech pathologist Birgit Risberg-Berlin for help regarding speech valve assessment. We are also grateful to the Stiftelsen Assar Gabrielssons Fond for financial support.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Sahlgrenska University Hospital, 413 45, Göteborg, Sweden

    H. Bergquist, H. Ejnell & M. Ruth

  2. Department of Radiology, Sahlgrenska University Hospital, 413 45, Göteborg, Sweden

    M. Andersson & M. Hellström

  3. Department of Surgery, Karolinska University Hospital/Huddinge, Stockholm, Sweden

    L. Lundell

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  1. H. Bergquist
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  2. M. Andersson
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  3. H. Ejnell
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  4. M. Hellström
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  5. L. Lundell
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  6. M. Ruth
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Correspondence to H. Bergquist.

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Bergquist, H., Andersson, M., Ejnell, H. et al. Functional and Radiological Evaluation of Free Jejunal Transplant Reconstructions After Radical Resection of Hypopharyngeal or Proximal Esophageal Cancer. World J Surg 31, 1988–1995 (2007). https://doi.org/10.1007/s00268-007-9162-8

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  • DOI: https://doi.org/10.1007/s00268-007-9162-8

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