A Multi-Institutional Study of Reconstruction for Laryngopharyngoesophagectomy

Abstract

There is no standard reconstructive technique for cancer ablation in head and neck lesions. The wide variety of reconstructive techniques results in big differences in outcomes among each institution, so we carried out a multi-institutional study of reconstructive techniques, and investigated the outcomes for 10 years.In order to standardize the range of ablation, only patients who had a reconstruction after pharyngolaryngoesophagectomy for hypopharyngeal cancer were included in this study. 764 patients were enrolled, of whom 715 patients (93.7%) were reconstructed with jejunum. There were differences among each institution's situation regarding the ratio of preoperative radiation and chemotherapy, total operation time, total volume of bleeding, ratio of abscess formation and fistula formation, duration of fast and hospital stay after operation.There was a correlation between long operation time and much bleeding. There was also a correlation between a large number of operations and short operation time. There was no correlation between the use of PGE1 and the risk of thrombosis. Preoperative radiation delayed wound healing significantly. We studied a multivariate analysis on each factor. The use of penrose drain and long operation time were significant risk factors of abscess or fistula formation. Based on these results, we would like to standardize reconstructive technique.

Efficacy of Tensed and Straight Free Jejunum Transfer for the Reduction of Postoperative Dysphagia

“… 5 However, FJT after TPLE is associated with postoperative dysphagia at various rates and degrees. 1 , 6 , 7 A previous study found dysphagia after FJT in 49.8% of patients among 764 retrospectively accumulated subjects, which is the largest multi-institutional study conducted in the Japanese population. 6 Possible causes of dysphagia include anastomotic stricture, cancer recurrence, perioperative irradiation, and intestinal peristalsis.…”

Background Factors Associated with Postoperative Complications in Patients with Advanced Hypopharyngeal Cancers Undergoing Total Pharyngolaryngoesophagectomy Followed by Free Jejunal Flap Reconstruction

“…For safety and restoring oral ingestion early, the free jejunal flap is the first-choice material for reconstructive surgery after TPLE for advanced hypopharyngeal cancer. [4][5][6] At our hospital, the free jejunal flap was selected as a material for reconstruction following TPLE in all cases. With respect to intraoperative factors (surgery duration and blood loss) and the length of postoperative hospital stay, our results were equivalent or superior to those in other institutions.…”

“…With respect to intraoperative factors (surgery duration and blood loss) and the length of postoperative hospital stay, our results were equivalent or superior to those in other institutions. 4,7 Typical complications after TPLE and free jejunal flap reconstruction included esophagojejunal anastomotic stricture, necrosis of the grafted flap resulting from clot formation in the anastomosed blood vessels, anastomotic suture failure, bowel obstruction, and stenosis of the tracheostoma. 8 In the present study, esophagojejunal anastomotic stricture was the most frequent complication.…”

Risk factors of thrombosis in a single method of microsurgical head and neck reconstruction: A multi‐institutional study of 773 reconstructions with a free jejunal graft after total pharyngolaryngoesophagectomy for hypopharyngeal cancer

“…The statistical analysis was conducted using SPSS 22.0 (IBM, Armonk, NY). The present study used data collected in a past survey entitled “Research for establishing plastic and reconstructive surgery for surgical cancer therapy” supported by a Grant‐in‐Aid for Cancer Research (grant 17‐5) from the Ministry of Health, Labor and Welfare of Japan . Permission for use of the data was newly obtained from the Institutional Review Boards of all participating institutions.…”