Reconstruction of Hypopharyngeal and Esophageal Defects Using a Gastric Tube after Total Esophagectomy and Pharyngolaryngectomy

Abstract

Aim: This study investigated the value of gastric tube during surgery for advanced hypopharyngeal and cervical esophageal cancer. Method: From November 2007 to December 2012, 42 patients underwent total pharyngo-laryngo-esophagectomy because of advanced hypopharyngeal or cervical esophageal cancer and were reconstructed with a gastric tube. Clinical swallowing function, morbidity, overall survival, and progression-free survival were evaluated postoperatively. Result: There were no severe complications, including no gastric necrosis, surgery-related postoperative morbidity, hemothorax, thoracostomach, or severe reflux esophagitis. Anastomotic leakage occurred in 2 cases, and these patients healed spontaneously with conservative management. Pulmonary infection developed in 5 patients. Anastomotic stenosis occurred in 2 cases and was managed with endoscopic dilatation. Regurgitation during the night was observed in 5 cases and was controlled by medication. All the patients regained their swallowing ability and thereby increased their quality of life. All patients were followed for 30-60 months; 2 of them were lost 6 months after surgery. The 3-year overall and progression-free survival rates were 58.1 and 56.2% respectively, and the 5-year overall and progression-free survival rates were 27.6 and 21.8%, respectively. Conclusion: Reconstruction by gastric tube is a dependable one-stage procedure that restores gastrointestinal continuity after total pharyngo-laryngo-esophagectomy.

Use of free modified jejunal flaps to reconstruct pharyngoesophageal defects with preservation of the larynx in three cases

“…4 Among reconstruction procedures, the tube-skin flap and gastric tube are not likely to fill large and complex defects because of their bulky volume and limited donor size (Figure 1b,c). 5 In addition, the gastric pull-up or stomach "patch" cannot be used to repair pharyngeal defects at higher positions because of the size of the stomach and the loss of stomach capacity. 5 The jejunum is a reconstructive choice for hypopharyngeal and cervical esophageal defects.…”

“…5 In addition, the gastric pull-up or stomach "patch" cannot be used to repair pharyngeal defects at higher positions because of the size of the stomach and the loss of stomach capacity. 5 The jejunum is a reconstructive choice for hypopharyngeal and cervical esophageal defects. Miyamoto et al 6 used a jejunal patch to reconstruct a hypopharyngeal defect with laryngeal preservation.…”

“… 5 In addition, the gastric pull‐up or stomach “patch” cannot be used to repair pharyngeal defects at higher positions because of the size of the stomach and the loss of stomach capacity. 5 …”

A Nationwide Survey on Digestive Reconstruction Following Pharyngolaryngectomy With Total Esophagectomy: A Multicenter Retrospective Study in Japan

“…To improve outcomes, some modifications, such as an additional microvascular anastomosis (MVA), an additional free graft transfer (FGT), and elongation of the gastric tube, have been proposed. [1][2][3][4][6][7][8][9][10][11][12][13][14][15] However, only a few studies have elucidated the optimal reconstruction method.…”

Covalent Immobilization of Glucose Oxidase onto Electro-synthesized Nanocomposite with PEDOT Derivative for Amperometric Glucose Biosensing

“…Carboxyl-functionalized CNTs have obtained much concern in recent years owing to their ability to reinforce properties, enhance interfacial interactions, improve the solubility and covalent immobilization of biomacromolecules [29][30][31][34][35][36][37]. Moreover, there is a great many reports for CNT/PEDOT composites in electrochemical chemo/biosensors [36][37][38][39][40][41].…”