Abstract
Objectives
The reconstruction of esophagus defects after hypopharyngeal and cervical esophageal carcinoma resection is an ongoing problem. The objective of this article was to investigate the techniques of the free jejunal graft for the reconstruction of hypopharyngeal and cervical esophagus and discuss the outcome related to the procedures.
Subjects and methods
From July of 2005 to December 2007, seven patients with hypopharyngeal and cervical esophageal cancer underwent free jejunal graft reconstruction of the hypopharyngeal and cervical esophagus. Their clinical data were retrospectively analyzed. All patients received postoperative radiotherapy and were followed up for 7–24 months.
Results
Despite the multistep and time-consuming procedure, free jejunal graft survival was 100%. Operation-induced complications did not occur in six patients. One patient developed pharyngeal fistula.
Conclusion
The present experience supports the use of free jejunal grafts in reconstruction of the hypopharyngeal and cervical esophagus defects after exenteration of the central compartment of the neck. A high successful rate with low incidence of complications in reconstruction of the hypopharyngeal and cervical esophagus was obtained in this study.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Makuuchi H. Reconstruction after thoracic esophagectomy. Nippon Geka Gakkai Zasshi 2008;109(5):256–260.
Bakamjian VY. A ten stage method for pharyngoesophageal reconstruction of the cervical esophagus and pharynx. Plast Reconstr Surg 1965;36:509. doi:10.1097/00006534-196508000-00004.
Carlson GW, Schusterman MA, Guillamendegui OM. Total reconstruction of the hypopharynx and cervical esophagus: a 20-year experience. Ann Plast Surg 1992;29:408–412. doi:10.1097/00000637-199211000-00005.
Miller JI, Lee RB. Free jejunal interposition of the esophagus. Semin Thorac Cardiovasc Surg 1992;4:286–291.
Cahow CE, Sasaki CT. Gastric pull-up reconstruction for pharyngo-laryngoesophagectomy. Arch Surg 1994;129:425–430.
Sasaki CT, Salzer SJ, Cahow CE, Son Y, Ward B. Laryngopharyngoesophagectomy for advanced hypopharyngeal and esophageal squamous cell carcinoma: the Yale experience. Laryngoscope 1995;105:160–163. doi:10.1288/00005537-199502000-00009.
Azurin DJ, Go LS, Kirkland ML. Palliative gastric transposition following pharyngolaryngoesophagectomy. Am Surg 1997;63:410–413.
Sobin LH, Wittekind CH. UICC TNM classification of malignant tumours, 6th edn. New York: Wiley, 2002.
Shirakawa Y, Naomoto Y, Noma K, Ono R, Nobuhisa T, Kobayashi M, Fujiwara T, Noguchi H, Ohkawa T, Yamatsuji T, Haisa M, Matsuoka J, Gunduz M, Tanaka N. Free jejunal graft for hypopharyngeal and esophageal reconstruction. Langenbecks Arch Surg 2004;389:387–390.
McCarthy CM, Kraus DH, Cordeiro PG. Tracheostomal and cervical esophageal reconstruction with combined deltopectoral flap and microvascular free jejunal transfer after central neck exenteration. Plast Reconstr Surg 2005;115(5):1304–1310.
Schsterman MA, Shestak K, deVries EJ, Swartz W, Jones N, Johnson J, Myers E, Reilly J Jr. Reconstruction of the cervical esophagus: free jejunal transfer versus gastric pull-up. Plast Reconstr Surg 1990;85(1):16–21.
Schuchert MJ, Pettiford BL, Landreneau JP, Waxman J, Kilic A, Santos RS, Kent MS, El-Sherif A, Abbas G, Luketich JD, Landreneau RJ. Transcervical gastric tube drainage facilitates patient mobility and reduces the risk of pulmonary complications after esophagectomy. J Gastrointest Surg 2008;12(9):1479–1484.
Bancu S, Zamfir D, Bara T, Butyurka A, Eşianu M, Borz C, Popescu G, Török A, Bancu L, Turcu M. Cervical anastomotic fistula in surgery of the esophagus. Chirurgia (Bucur) 2006;101(1):31–33.
Bradone M, Alessiani M, Zonta S, Longoni M, Faillace G, Benazzo M, Occhini A, Dionigi P. Il prelievo laparoscopico di un lembo libero di digiuno per la ricostruzione dell' esofago cervicale.. Minerva Chir 2006;61(2):171–175.
Wadsworth JT, Futran N, Eubanks TR. Laparoscopic harvest of the jejunal free flap for reconstruction of hypopharyngeal and cervical esophageal defects. Arch Otolaryngol Head Neck Surg 2002;128:1384–1387.
Hiroto I, Nomura Y, Sueyoshi K, Mitsuhashi S, Ichikawa A, Kurokawa H. Pathological studies relating to neoplasms of the hypopharynx and the cervical esophagus. Kurume Med J 1969;16:127–133.
Harrison DFN. Pathology of hypopharyngeal cancer in relation to surgical management. J Laryngol Otol 1970;84:349–366.
Davidge-Pitts KJ, Mannel A. Pharyngolaryngectomy with extrathoracic esophagectomy. Head Neck Surg 1983;6:571–574.
Ho CM, Ng WF, Lam KH, Wei W, Yuen APW. Submucosal tumor extension in hypopharyngeal cancer. Arch Otolaryngol Head Neck Surg 1997;123:959–965.
Buckley JG, MacLennan K. Cervical node metastases in laryngeal and hypopharyngeal cancer: a prospective analysis of prevalence and distribution. Head Neck 2000;22:380–385.
Ho CM, Lam KH, Wei W, Yuen PW, Lam LK. Squamous cell carcinoma of the hypopharynx—analysis of treatment results. Head Neck 1993;15:405–412.
Davidge-Pitts KJ, Mannel A. Pharyngolaryngectomy with extrathoracic esophagectomy. Head Neck 1983;6:571–574.
Triboulet JP, Mariette C, Chevalier D, Amrouni H. Surgical management of carcinoma of the hypopharynx and cervical esophagus. Arch Surg 2001;136:1164–1170.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zhao, D., Gao, X., Guan, L. et al. Free Jejunal Graft for Reconstruction of Defects in the Hypopharynx and Cervical Esophagus Following the Cancer Resections. J Gastrointest Surg 13, 1368–1372 (2009). https://doi.org/10.1007/s11605-009-0877-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-009-0877-8