200 freie Jejunumtransplantationen: Lohnt der große operative Aufwand?*

Abstract

From 1983 to 1992, 216 free jejunal transplants were performed after resection of malignant tumours for reconstructing the upper oesophageal tract. In two patients reconstruction was performed secondarily and in four cases within the framework of recurrence treatment. In 25 cases the jejunal transplant was sewn in tubular form to the circular insert of the hypopharynx, whereas in the remaining 188 cases the jejunum transplant was sewn as patch. A jejunum transplant was most frequently employed in the tonsillar region (n = 75). Reconstruction of the body of the tongue was performed in 42 cases and of the hypopharynx in 29 cases. Of the 213 patients treated, 175 were irradiated postoperatively. The most severe complications were in 5 cases death from the sequels of the operating, abdominal complications in 15 cases and complete loss of the transplant in 22 cases. Protracted inability to swallow occurred in 15 cases and pneumonia in 16 patients. The five-year survival probability was 39% for the 42 patients suffering from carcinomas of the oral cavity, 53% for the 90 patients with oropharyngeal carcinoma in stage III and 33% in stage IV, as well as 40% with the 29 patients suffering from hypopharyngeal carcinomas. An essential advantage of the free jejunum transplants were the excellent functional reconstruction results. This is demonstrated by examples of various cases. Since the number of treated patients is still too low, it is at present not yet possible to compare this approach with other therapeutic concepts, such as enoral laser surgery resection or radiochemotherapy.

Jejunum interposition after cervical esophageal resection*

“…Other authors have reported 51% for the 2-year period 16 and 25±40% for 5-year survival. 4,7,19 Our ®ndings are similar to those described by other authors, who have reported failure rates between 3% and 11% (Table 2). 4,9,12,20 In comparison with gastric pull-up (Table 3), the total complication rate associated with the jejunal graft is lower.…”

“…In our series, the 2‐year survival rate was 59% (13 out of 22 patients) and the 5‐year survival rate was 44% (7 out of 16 patients). Other authors have reported 51% for the 2‐year period 16 and 25–40% for 5‐year survival 4 , 7 , 19 …”

“…Today, several options for a single‐stage repair of the cervical esophagus are available (Table 1). Among these options, the jejunal autograft is the method of choice because it has several advantages: the complication rate is low, the best functional results are recorded, and the harvesting defect is esthetically and functionally of minor importance 3–9 …”

Free jejunum transfers for functional reconstruction after tumour resections in the oral cavity and the pharynx: Changes of morphology and function

“…In the oral cavity the jejunal graft is superior to any other donor tissue because of its thinness and versatility, especially as far as the three-dimensional reconstruction of large postexcisional defects is concerned. 7 It also seems that the mucosal tissue is sufficient for mechanical loading in the oral cavity. In the pharynx, the jejunum conduit best provides the properties of the tissue replaced and represents less donor-site morbidity and fewer complications than transferred ileum, gastric antrum, or colon.…”