A survey of feeding and swallowing function after free jejunal flap reconstruction in cases of head and neck cancer

Abstract

Reconstructive surgery using the free jejunum flap for locally advanced head and neck cancer is effective in preserving the swallowing function; however, it does not allow normal oral intake in all patients. A total of 47 patients underwent surgery at Nara Medical University between Jan 2010 and Dec 2019. The patients' ages ranged from 48 to 86 years. Sites were the hypopharynx (33 cases), larynx and cervical esophagus (5 cases each) and oropharynx (4 cases). Swallowing function was assessed using videofluorography, from the start of oral intake to discharge, as well as meal form at discharge. Lateral-retropharyngeal-lymph node dissection (LRPLND), preoperative radiation therapy, extended resection to the nasopharynx and incidence of stenosis in the jejuno-esophageal anastomosis were examined. Significant differences were revealed in the scores of pharyngeal residues of contrast medium and pharyngeal contraction, with and without preoperative radiotherapy. LRPLND did not affect swallowing function; dissection group cases had lower scores for soft palate elevation. Overall, resection extended to the nasopharynx, and the anastomosis method did not affect scores of swallowing function.

The Ischemic Tolerance up to Four Hours of Free Jejunum Flap: A Retrospective Cohort Study

“…27 In previous reports, preoperative RT was viewed as having an overwhelmingly negative impact on perioperative complications of FJT. 1,16,17,20,21,24,25 In this study, however, preoperative RT was not found to be a significant independent factor in perioperative complications or postoperative dysphagia, while postoperative RT was an independent factor for dysphagia. As for preoperative RT, perioperative complications may be affected by residual tissue and recipient vessels damaged by RT, but the disadvantage can be eliminated by resection of damaged tissue and replacement with a new FJ and accompanying mesentery, and also by selecting anastomotic vessels in good condition.…”

“…Dysphagia after 6 months postoperatively: ischemia time (subject of the present study), BMI/history of neck surgery/radical neck dissection/postoperative RT/postoperative chemotherapy/recurrence within 1 year (significant trend in the univariate analysis), preoperative RT 1 20 25 (previous report).…”

“…Abbreviation: N/A, not available. a p < 0.1. b p < 0.05. surgery/radical neck dissection/postoperative RT/postoperative chemotherapy/recurrence within 1 year (significant trend in the univariate analysis), preoperative RT1,20,25 …”