Esophageal reconstruction after oncological total laryngopharyngoesophagectomy: Algorithmic approach

Chang, Tsuey Yu; Hsiao, Jenn Ren; Lee, Wei Ting; Ou, Chien-Hui; Yen, Yi‐Ting; Tseng, Yau‐Lin; Pan, Shiyan; Shieh, Shyh Jou; Lee, Yao Chou

doi:10.1002/micr.30304

Cited by 7 publications

(3 citation statements)

References 37 publications

(58 reference statements)

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“…In view of the possibility that mass tissue resection caused by tissue adhesion and necrosis of PESCC after radiotherapy failure may have a greater impact on postoperative swallowing function, we evaluated ALT and JF on swallowing function at the 6th and the 12th month postoperatively to improve the accuracy of analyzing the effects of ALT and JF on postoperative swallowing function reconstruction. Our results suggested that although the number of patients with dysphagia including liquid diet, partial tube feeding and total tube feeding in ALT and JF increased gradually with the protract of time, there was no statistical significance between the two groups, which was similar to the results of previous study [ 23 ]. However, in previous study, the results of Chan et al suggested that JF reconstruction of peripharyngectomy defects can achieve better functional outcomes than ALT, which may be different from our results, possibly because our study included patients after radiotherapy and had a small sample size [ 19 ].…”

Section: Discussionsupporting

confidence: 86%

Comparison between anterolateral thigh free flap and jejunal flap for tissue reconstruction in patients underwent resection of pharyngoesophageal squamous cell carcinoma after radiotherapy failure: a retrospective study

et al. 2021

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Background Anterolateral thigh (ALT) free flap and jejunal flap (JF) were commonly used in tissue reconstruction for pharyngoesophageal squamous cell carcinoma (PESCC) with worsening tissue adhesion and necrosis after radiotherapy failure. However, the results of tissue reconstruction and postoperative complications of these two flaps are controversial. The purpose of this study was to compare outcomes between group ALT free flap and group JF in PESCC after radiotherapy failure. Methods Intraoperative information and postoperative outcomes of patients with PESCC after radiotherapy failure who underwent ALT and JF reconstruction from January 2005 to December 2019 were compared and analyzed. Results The defect size of ALT (Numbers, 34) and JF (Numbers, 31) was 36.19 ± 11.35 cm2 and 35.58 ± 14.32 cm2 (p = 0.884), respectively. ALT and JF showed no significant difference in operation time (p = 0.683) and blood loss (p = 0.198). For postoperative outcomes within 30 days both in recipient site and donor site including wound bleeding, wound dehiscence, wound infection, and pharyngocutaneous fistula, ALT free flap and JF showed similar results. Flap compromise (Numbers, 2 VS.3, p = 0.663), flap take backs (Numbers, 1 VS.1, p = 1.000), partial flap failures (Numbers, 4 VS.2, p = 0.674), and total flap failures (Numbers, 0 VS.0, p = 1.000) showed no difference between the two groups. In addition, no significance was found in hypoproteinemia between the two groups (Numbers, 4 VS.2, p = 0.674). ALT free flap was not statistically different from JF in the incidence of dysphagia at the postoperative 6 months (Numbers of liquid diet, 5VS.5; Numbers of partial tube feeding, 6VS.7; Numbers of total tube feeding, 3VS.1, p = 0.790) and 12 months (Numbers of liquid diet, 8VS.7; Numbers of partial tube feeding, 8VS.7; Numbers of total tube feeding, 5VS.5, p = 0.998). The cause of dysphagia not found to differ between the two groups both in postoperative 6 months (p = 0.814) and 12 months (p = 0.845). Conclusion Compared with JF, ALT free flap for PESCC patients after radiotherapy failure showed similar results in postoperative outcomes. ALT free flap may serve as a safe and feasible alternative for PESCC patients after radiotherapy failure.

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Section: Discussionsupporting

confidence: 86%

Comparison between anterolateral thigh free flap and jejunal flap for tissue reconstruction in patients underwent resection of pharyngoesophageal squamous cell carcinoma after radiotherapy failure: a retrospective study

et al. 2021

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“…Previous studies have mainly focused on surgical techniques aimed at preventing early complications, such as leakage, fistula, and stricture, rather than long-term issues such as side effects of radiation therapy [ 11 , 12 , 13 , 14 , 15 ]. In contrast to these early complications, one of the most important long-term consequences in such patients is the decline in dietary function, which has a profound effect on the quality of life.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Postoperative Radiotherapy on Dietary Function of Head and Neck Cancer Patients after Pharyngoesophageal Reconstruction with Free Jejunal Flap

Chang

Wang

Ahn

et al. 2022

JCM

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This study investigated the impact of postoperative radiotherapy (PORT) on dietary function in patients who underwent pharyngoesophageal defect reconstruction using a free jejunal flap. A retrospective chart review of 36 patients who underwent circumferential pharyngoesophageal defect reconstruction using a free jejunal flap was performed. The European Organization for the Research and Treatment of Cancer head and neck cancer module questionnaire was used. Five items related to dietary function were selected and analyzed for changes in scores before and after PORT. Both the PORT and non-PORT groups showed improved dietary function before surgery, and no significant changes were noted at 3 and 12 months postoperatively. Repeated measures ANOVA showed that PORT had no significant impact on dietary function. In univariate analysis, no variable was a significant predictor of the score at 12 months, postoperatively. Previous radiotherapy and neck dissection had a close statistically significant relation. The multivariate analysis showed that neoadjuvant chemotherapy, previous radiotherapy, and neck dissection were significant predictors of the score at 12 months, postoperatively. PORT did not show a significant effect on the 12 months postoperative score. Free jejunal flap is an effective pharyngoesophageal defect reconstruction method that does not cause any dietary function disruption after PORT.

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“…Gastric pull-up is the oldest technique still in use for reconstruction after TPLE. When introduced in 1960, the procedure was characterized by its a one-stage operation, low mortality, and the patients not being worse off than before the operation [19] . However, the limited extension of gastric tube might put the anastomosis under tension if the resection margin was too high in the oropharynx or nasopharynx.…”

Section: Introductionmentioning

confidence: 99%

Healing the gap: the evolution of esophageal substitute and quality of life in patients undergoing total pharyngolaryngoesophagectomy with reconstruction

Chang¹,

Chang²,

Tang³

et al. 2021

PAR

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Aim: Hypopharyngeal squamous cell carcinoma is reportedly one of the most aggressive primary cancers, and surgical resection continues to be the standard therapeutic choice. In patients with hypopharyngeal cancer involving the esophagus or synchronous hypopharyngeal and esophageal cancer, total pharyngolaryngoesophagectomy (TPLE) is indicated to control both malignancies at the same time. Reconstruction remains challenging with regard to the length of the substitute for the esophagus as well as the donor site morbidity. We reported our long-term follow-up and the outcome of the quality of life (QoL). Methods:We retrospectively reviewed the records of all patients who underwent TPLE between January 2012 and December 2020. Information was collected on sex, age, surgical indications, operative time, postoperative complication, swallowing function, hospital stay, and survival. Quality of life scores were acquired by World Health Organization Quality of Life-Brief (WHOQOL-BREF) questionnaires and completed at the outpatient clinic. Gaussian kernel-smoothing was applied to estimate the dynamic changes of QoL function.Results: A total of 40 patients undergoing oncologic pharyngolaryngoesophagectomy were enrolled in this study. There were 26 patients (65%) undergoing gastric tube reconstruction with direct anastomosis to the oropharynx (GP group), 7 patients (18%) undergoing additional free jejunal flap to bridge the gap between the gastric tube and oropharynx (GP-JF group), 4 patients (10%) undergoing additional free anterolateral thigh flap to bridge the gap and resurface the neck skin (GP-ALT group), and 3 patients (8%) undergoing colon interposition (CI group). The leakage rate in each group was 50% for GP group, 29% for GP-JF group, 50% for GAP-ALT group, and 67% for CI group. The mean operation time was 1010 ± 195 min. Although the overall leakage rate was 47.5%, only 15% of the patients needed further surgical intervention. One patient (2.5%) died with persistent leakage and pneumonia. In terms of life quality assessment, the response rate for the QoL questionnaire was 50%. We found the overall QoL deteriorated for the first year after operation, but it gradually improved and even surpassed the patient pretreatment scores by the end of the second year after operation. Conclusion:The gap caused by TPLE in patient, perioperative morbidity, and postoperative quality of life could be managed by the evolution of esophageal substitute, surgical techniques, perioperative wound care, and evaluation of the quality of life.

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Esophageal reconstruction after oncological total laryngopharyngoesophagectomy: Algorithmic approach

Abstract: The proposed algorithm that ranks gastric pull-up as a priority and uses additional free tissue transfer to overcome the anastomotic tension or associated neck-skin defect is feasible.

Cited by 7 publications

References 37 publications

Comparison between anterolateral thigh free flap and jejunal flap for tissue reconstruction in patients underwent resection of pharyngoesophageal squamous cell carcinoma after radiotherapy failure: a retrospective study

Comparison between anterolateral thigh free flap and jejunal flap for tissue reconstruction in patients underwent resection of pharyngoesophageal squamous cell carcinoma after radiotherapy failure: a retrospective study

The Impact of Postoperative Radiotherapy on Dietary Function of Head and Neck Cancer Patients after Pharyngoesophageal Reconstruction with Free Jejunal Flap

Healing the gap: the evolution of esophageal substitute and quality of life in patients undergoing total pharyngolaryngoesophagectomy with reconstruction

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