Analysis of functional results and quality of life following free jejunal flaps for reconstruction after upper aerodigestive neoplastic resection: the St James's experience

Hanson, R.; Chow, T.; Feehan, Edward B.; Eadie, Patricia; Timon, Conrad; Keogh, Steven

doi:10.1016/j.bjps.2006.11.012

Cited by 27 publications

(24 citation statements)

References 28 publications

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“…Most studies only describe wound complications in 27–50% of the patients [5, 9], which is comparable with 40% in our overall study population, when only considering the wound complications. Our in-hospital mortality rates of 4% for jejunum interpositions and 16% for gastric pull-up procedures are consistent with other reports [5–7, 9, 10, 14, 15]. …”

Section: Discussionsupporting

confidence: 92%

“…To our knowledge, these are the first results that fully confirm the experience-based presumption of the wide extent of the postoperative morbidity. Complete oral intake, defined as the moment when enteral supplementation is no longer required, was achieved in 97% of patients, an excellent outcome as compared to the reported 65–81% in the literature [7, 10, 21, 22]. However, despite the lack of need for a feeding tube, in many cases patients are restricted to a soft diet, which could explain the moderate problems in social eating (mean 29/100).…”

Section: Discussionmentioning

confidence: 81%

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Early and long-term morbidity after total laryngopharyngectomy

Keereweer

Wilt

Sewnaik

et al. 2010

Eur Arch Otorhinolaryngol

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To determine the early and long-term morbidity of patients treated with a total laryngopharyngectomy and reconstruction using a jejunum interposition or gastric pull-up procedure. It is a retrospective study; and it is conducted in tertiairy referral center. Sixty-three patients were included in whom 70 reconstructions were performed (51 jejunum interpositions and 19 gastric pull-up procedures) between 1990 and 2007. The studied parameters were success rate of the reconstruction, early and long-term complication rate, and functional outcome including quality of life. Subjective quality of life analysis was determined by two questionnaires: the EORTC Quality of Life Questionnaire (QLQ)-C30 Dutch version 3.0, and the EORTC-Head and Neck (H & N 35). The success rates were 84 and 74%, respectively. The procedures were associated with a high complication rate (63% after jejunum interposition and 89% after gastric pull-up), and a lengthy rehabilitation. Surviving patients were found to have a good long-term quality of life. Complete oral intake was achieved in 97%, and speech rehabilitation in 95%. These procedures are associated with significant morbidity, high complication rates, lengthy rehabilitation, but a good long-term quality of life.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 81%

Early and long-term morbidity after total laryngopharyngectomy

Keereweer

Wilt

Sewnaik

et al. 2010

Eur Arch Otorhinolaryngol

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“…Oniscu et al [18] reported a language recovery rate of 87% (13/15) with a Blom-Singer prosthesis. Some reported that speech function can be well recovered by electronic larynx [19]. We have kept providing patients after total laryngectomy with esophageal pronunciation training courses for more than 20 years and most patients can manage the technique after training [20].…”

Section: Discussionmentioning

confidence: 99%

Morbidity and Functional Outcomes following Free Jejunal Flap Reconstruction for Head and Neck Cancer

Song¹,

Zhu²,

Dong

et al. 2017

ORL

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Aim: To evaluate the morbidity and fundamental functional outcomes (swallow and speech) after free jejunal flap (FJF) reconstruction following total pharyngolaryngo-esophagectomy (PLE) in China. Methods: 18 patients with FJF reconstruction after total PLE were retrospectively reviewed. Scheduled barium swallow test was performed 7-10 days postoperatively. Rehabilitation of swallowing and speech for patients was assessed by the Performance Status Scale for Head and Neck Cancer Patients. Results: 8 patients died of tumor recurrence and 2 patients died of other reasons (cerebrovascular disease and respiratory disease, respectively). The 1-year, 2-year, and 3-year survival rates were 70.5, 49.4, and 33.8%, respectively. 83.3% of all patients could tolerate soft chewable foods, such as cooked vegetables, fish, hamburger, and small pieces of meat. 2 patients with early stenosis at upper anastomotic sites were with good swallowing function; while 2 patients with early stenosis at lower anastomotic sites were found to have difficulty in oral diet. 2 (11.1%) patients with larynx-preserving pharyngo-esophagectomy showed no compromise in speech. Only 2 (11.1%) patients underwent primary tracheoesophageal puncture for inserting an indwelling voice prosthesis for speech, and both patients achieved functional tracheoesophageal speech. The remaining 14 (77.8%) patients with total PLE did not resume functional speech. Conclusion: Postoperative barium swallow examination is helpful to predict long-term anastomotic stenosis. Good functional swallow rehabilitation is achieved following FJF reconstruction after total PLE or a larynx-preserving procedure. However, the speech outcomes are not satisfactory. It raises the demand of enhancement of functional recovery so that quality of life can be improved for these patients in China.

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“…Insufficient blood supply mostly leads to direct postoperative failure of reconstruction, accounting for 5-10% of the patients [6,7,8,9,10,11]. Ischemia for more than 3 h causes irreversible damage to the jejunum, making the salvage with thrombectomy and reanastomosis impossible and requiring a secondary reconstruction [18,19].…”

Section: Discussionmentioning

confidence: 99%

“…However, total necrosis of the graft sometimes occurs and remains a major complication, mainly due to insufficient blood supply [6,7,8,9,10,11]. Choices of subsequent secondary reconstruction have been reported less frequently compared with the widely reported success rate of free jejunal transfer [12,13,14,15,16].…”

Section: Introductionmentioning

confidence: 99%

Salvage Procedures after Total Necrosis of a Free Jejunal Graft

Song

Zhu

Wang

et al. 2015

ORL

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Purpose of the Study: To determine the appropriate salvage method after total necrosis of a jejunal graft after reconstruction of total laryngopharyngoesophagectomy or a larynx-preserving operation, considering the complexity of medical service in China. Procedures: We reviewed 5 patients with a mean age of 61 years who developed total jejunal graft necrosis and underwent reconstruction of a free jejunal transfer in our hospital. The total number and choice of salvage procedures, the symptoms and the results of salvage for the 5 patients have been reviewed. Results: Four of the 5 patients survived. One of them underwent gastric pull-up reconstruction and recovered well. One patient died due to severe infection after the loss of the jejunal graft and secondary gastric pull-up reconstruction. A temporary external fistula was formed in 3 patients after the initial jejunal graft necrosis, 2 of which underwent fistula repair 6 and 5 months later, while one went on long-term gastric tube feeding. Conclusion: Our results suggest that a temporary external fistula formation is an optional secondary salvage procedure after total necrosis of an initial jejunal graft, considering the relatively low quality of medical service in China.

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Analysis of functional results and quality of life following free jejunal flaps for reconstruction after upper aerodigestive neoplastic resection: the St James's experience

Cited by 27 publications

References 28 publications

Early and long-term morbidity after total laryngopharyngectomy

Early and long-term morbidity after total laryngopharyngectomy

Morbidity and Functional Outcomes following Free Jejunal Flap Reconstruction for Head and Neck Cancer

Salvage Procedures after Total Necrosis of a Free Jejunal Graft

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