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

Tachibana, Satsuki; Miyamoto, Shimpei; Goto, Takahiro; Ishida, Katsuhiro; Iida, Takuya; Okazaki, Mutsumi; Yoshida, Shigeaki; Nomura, Shosaku; Hayashi, Ryuichi; Sakuraba, Minoru

doi:10.1097/gox.0000000000001599

Cited by 5 publications

(9 citation statements)

References 10 publications

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“…Anastomotic stricture was observed in 11% of the patients in this study, which is consistent with the incidence of 3–11% reported previously [4, 6, 7]. Our findings suggest that postoperative radiation therapy may increase the risk of anastomotic stricture, in agreement with the results of a prior investigation [15].…”

Section: Discussionsupporting

confidence: 93%

“…We observed cervical skin flap necrosis in 34% of patients in our study. The incidence has been reported to range from 1% to 17% [2, 4, 5]. Our study reported a 0% incidence of cases requiring reoperation in operation room, which is similar to the 1% incidence in other study [2].…”

Section: Discussionsupporting

confidence: 89%

“…Lymph leak was observed in 24% of patients in our study, whereas it has been reported previously to occur in the range of 4–9% [2–4]. The high incidence in our study might be due to the retrospective nature of the study and that we included lesions that were not severe.…”

Section: Discussioncontrasting

confidence: 57%

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Factors Associated with Complications after Total Pharyngo-Laryngo-Esophagectomy and Free Jejunal Flap Reconstruction

Ikuta

Suyama

Fukuoka

et al. 2023

ORL

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Introduction: Free jejunal flap (FJF) reconstruction is a standard procedure for pharyngeal and cervical esophageal defects resulting from head and neck cancer resection. However, improvements in patients’ quality of life after surgery require a further statistical approach. Methods: An observational, retrospective, multivariate analysis was designed to report the incidence of postoperative complications and their association with clinical factors in 101 patients who underwent total pharyngo-laryngo-esophagectomy and FJF reconstruction for head and neck cancer at a university hospital between January 2007 and December 2020. Results: Postoperative complications were observed in 69% of patients. In the reconstructive site, anastomotic leak, observed in 8% of patients was associated with vascular anastomosis in the external jugular vein system (age-adjusted odds ratio [OR]: 9.05, p = 0.044) and anastomotic stricture, observed in 11% of patients was associated with postoperative radiotherapy (age-adjusted OR: 12.60, p = 0.02). Cervical skin flap necrosis was the most common complication (34%) and was associated with vascular anastomosis on the right cervical side (age- and sex-adjusted OR: 4.00, p = 0.005). Conclusion: Although FJF reconstruction is a useful procedure, 69% of patients suffer a postoperative complication. We suppose that anastomotic leak is related to the low blood flow resistance of the FJF and inadequate drainage of the external jugular venous system, and anastomotic stricture is related to the vulnerability of the intestinal tissue to radiation. Furthermore, we hypothesized that the location of the vascular anastomosis may affect the mesenteric location of the FJF and the dead space in the neck, leading to the development of cervical skin flap necrosis. These data contribute to increasing our knowledge about postoperative complications related to FJF reconstruction.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 89%

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Factors Associated with Complications after Total Pharyngo-Laryngo-Esophagectomy and Free Jejunal Flap Reconstruction

Ikuta

Suyama

Fukuoka

et al. 2023

ORL

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“…It is worth noting that some cases in this study were enrolled during the timeframe of our previous report. 3,14 However, the objectives and analysis methods differ entirely.…”

Section: Methodsmentioning

confidence: 99%

“…Free jejunum transfer (FJT) following total pharyngo-laryngo-esophagectomy (TPLE) is globally recognized as a reliable reconstruction method. [1][2][3] However, the intestinal tract is said to be more vulnerable to ischemia than a normal free flap, and basic animal studies have shown that ischemiainduced irreversible tissue degeneration can begin as early as 2 to 3 hours. [4][5][6] In clinical practice, there is a consensus that a shorter ischemic time is better for the FJT, so that the vascular anastomosis is usually completed prior to the completion of the jejunal anastomosis.…”

mentioning

confidence: 99%

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

Kagaya,

Takanashi,

Arikawa

et al. 2024

J Reconstr Microsurg

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Background While free jejunum transfer (FJT) following total pharyngo-laryngo-esophagectomy (TPLE) is a reliable reconstruction technique, the jejunum flap is viewed as more susceptible to ischemia than a standard free flap. Animal studies have indicated that the jejunum can tolerate ischemia for as little as two to three hours. Clinical studies also reported increased complications after the FJT with more than three hours of ischemia. Traditionally, our institution has carried out FJT with an initial intestinal anastomosis, followed by a vascular anastomosis, which often results in extended jejunal ischemia time. In this study, we retrospectively examined the actual tolerance of the jejunum to ischemia, considering perioperative complications and postoperative dysphagia. Methods We retrospectively studied 402 consecutive cases involving TPLE+FJT. Patients were divided into five groups based on jejunum ischemia time (~119 min, 120~149 min, 150~179 min, 180~209 min, 210 min~), with each variable and result item compared between the groups. Univariate and multivariate analyses were conducted to identify independent factors influencing the four results: three perioperative complications (pedicle thrombosis, anastomotic leak, surgical site infection (SSI)), and dysphagia at six months postoperatively. Results The mean jejunal ischemia time was 164.6±28.4 (90 -259) minutes. When comparing groups divided by jejunal ischemia time, we found no significant differences in overall outcomes or complications. Our multivariate analyses indicated that jejunal ischemia time did not impact the three perioperative complications and postoperative dysphagia. Conclusion In TPLE+FJT, a jejunal ischemia time of up to four hours had no effect on perioperative complications or postoperative dysphagia. The TPLE+FJT technique, involving a jejunal anastomosis first followed by vascular anastomosis, benefits from an easier jejunal anastomosis but suffers from a longer jejunal ischemia time. However, we found that ischemia time does not pose significant problems, although we have not evaluated the effects of jejunal ischemia extending beyond four hours.

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Reconstruction techniques using free jejunal transfer for total pharyngolaryngectomy with total glossectomy

Hidaka,

Miyamoto,

Oba

et al. 2024

Microsurgery

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BackgroundTotal pharyngolaryngectomy is sometimes combined with total glossectomy for advanced hypopharyngeal or cervical esophageal cancers involving the tongue base. The optimal reconstruction method for total pharyngolaryngectomy with total glossectomy has not been established due to a considerable diameter mismatch between the floor of mouth and the esophageal stump. This report describes two reconstruction methods using free jejunal transfer.MethodsFive consecutive patients who underwent total pharyngolaryngectomy with total glossectomy were included, with a mean age of 67.0 (range 55–75) years. Primary tumors included tongue, hypopharyngeal, cervical esophagus, and laryngeal cancers. The mean defect size was 17.0 (16–19) × 6.8 (6–7) cm. Surgical techniques involved either a simple incision or a two‐segment method to address the size mismatch between the jejunum and the floor of mouth. In the simple incision method, a longitudinal cut was made to the antimesenteric or paramesenteric border of a jejunum wall to expand the orifice. In the two‐segment method, a jejunal graft was separated into two segments to reconstruct the floor of mouth and the cervical esophagus, and these segments were connected with a longitudinal incision to the cervical esophageal segment to form a funnel‐shaped conduit.ResultsOf the five patients, three underwent the simple incision method and two the two‐segment method. Postoperative pharyngoesophagography showed a smooth passage for all patients. Postoperative courses were uneventful except for one flap loss due to arterial thrombosis. Four patients achieved oral feeding, while one became gastric‐tube dependent. At a mean follow‐up of 22.1 (4–39) months, one patient required tube feeding, two tolerated full liquid, and two consumed a soft diet.ConclusionsBoth the simple incision and two‐segment methods achieved satisfactory swallowing function. The choice between these reconstruction methods may depend on the extent of resection of the posterior pharyngeal wall.

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

Cited by 5 publications

References 10 publications

Factors Associated with Complications after Total Pharyngo-Laryngo-Esophagectomy and Free Jejunal Flap Reconstruction

Factors Associated with Complications after Total Pharyngo-Laryngo-Esophagectomy and Free Jejunal Flap Reconstruction

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

Reconstruction techniques using free jejunal transfer for total pharyngolaryngectomy with total glossectomy

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