Functional Long-Term Outcome of a Free Jejunal Transplant Reconstruction following Chemoradiotherapy and Radical Resection for Hypopharyngeal and Proximal Oesophageal Carcinoma

Abstract

Background/Aims: To evaluate the functional outcome of a reconstruction by a free vascularized jejunal transplant combined with a voice prosthesis after chemoradiotherapy and surgery for proximal oesophageal or hypopharyngeal cancer. Methods: Seven patients (6 men, mean age 52 years, range 28–70) with squamous cell cancer in the proximal oesophagus (n = 6) or the hypopharynx received preoperative chemoradiotherapy (40.8 Gy, cisplatinum and 5-FU) followed by a circumferential pharyngolaryngectomy and resection of the proximal oesophagus. A single-stage reconstruction was carried out with a free jejunal transplant using a microsurgical technique. A tracheojejunal puncture and insertion of a voice prosthesis (Provox I) was performed after 3 months in suitable cases. Results: All operations had a per- and postoperative uneventful course. Five patients were alive after a mean follow-up time of 5 years and 7 months after surgery (range 3 years 4 months to 7 years 10 months), while 2 patients died from metastases within 2 years after surgery. Postoperative examination showed histopathological down-staging in all cases. Relief of dysphagia was achieved in most cases. Good or average speech was recorded in 3 patients. Conclusion: Reconstruction after radical resection for proximal oesophageal and hypopharyngeal cancer can be carried out with low mortality, acceptable morbidity and a promising functional outcome.

The acute management and surgical reconstruction following failed esophagectomy in malignant disease of the esophagus

“…The method and route used for reconstruction is dependent on the length of defect, an adequate blood supply, a disease-free segment of organ to be used, the functional results, and the surgeon's preference. 10 Some have advocated colonic interposition, 11,12 while others favor a jejunal transfer, either 'free' 13,14 or with a 'supercharged' microanastomosis and pedicle. 15,16 The jejunum as an esophageal conduit was popularized in the 1950s, with Longmire 17 and Androsov 18 pioneering the techniques of microvascular anastomosis.…”

Indwelling voice prosthesis insertion after total pharyngolaryngectomy with free jejunal reconstruction

“…Several studies have reported on the use of prosthetics for voice restoration following TPL . However, most of these were small case series or included various reconstruction methods.…”

“…Several studies have reported on the use of prosthetics for voice restoration following TPL. 6,7,[9][10][11] However, most of these were small case series or included various reconstruction methods. Therefore, the features and complications of an indwelling voice prosthesis in patients who undergo TPL with free jejunal reconstruction have not been established in large cohorts.…”

Limited resection and free jejunal graft interposition for squamous cell carcinoma of the cervical oesophagus

“…The theoretical advantages of a free jejunal graft are easy harvesting, low donor‐site morbidity and good size approximation to the oesophageal lumen. In the past, radical surgery without neoadjuvant treatment resulted in high morbidity and a reduced quality of life, as laryngectomy was frequently performed at the same time11, 12, 18, 21. Nowadays, neoadjuvant therapy is included in the treatment for oesophageal cancer, making limited resection with a free jejunal graft interposition possible and resulting in an improved quality of life with preservation of the larynx and avoidance of persistent dysphagia.…”