Free Jejunal Autograft Reconstruction of the Pharyngoesophagus: Review of a 10‐year experience

Abstract

Seventeen patients underwent free jejunal autograft reconstruction of the pharyngoesophagus after ablative surgery for Stage III and IV squamous cell carcinoma of the cervical esophagus and hypopharynx. Postoperative complications included three perioperative deaths, three graft failures, six transient fistulas, and two early and one late fistula. The 5-year survival rate of patients with Stage III and IV hypopharyngeal carcinoma was 20% (one of five). The 4-year survival rate for patients with cervical esophageal carcinoma was 33% (one of three). This method of reconstruction is advocated as a reliable palliative procedure for patients with a dismal long-term survival.

Free jejunal graft for hypopharyngeal and esophageal reconstruction

“…The rate of post-operative complications in our patients was 9.3% (five patients), which, if compared with other reports of up to 25% [14], is considerably low. Nevertheless, the low rate of failure (3%-10%), low mortality and short-time hospitalization that has also been reported in previous studies [8,11,15] have convinced us that this is the best method to reconstruct hypopharynx and cervical esophagus after wide resections, and that is an invaluable technique in special cases, specially when stomach or colon are not available. However, the high rate of graft loss in the patients who underwent larynx-preserving cervical esophagectomy, aiming to get a better quality of life, seems to be a problematic.…”

Analysis of recurrence, complications, and functional results with free jejunal flaps

“…The length of hospital stay ranged from 9 to 47 days, with a mean of 21 days and a median of 15.5 days. Excluding the patient with perioperative death, 10 patients had excellent swallowing, one patient was able to maintain his weight with a liquid diet alone, one patient had marginal swallowing requiring enteral supplementation, four patients never swallowed successfully, and three patients had flap failure.…”

Colonic interposition and supercharge for esophageal reconstruction

“…The improvement in microsurgical techniques and availability of high-quality equipment has improved the safety of this technique [8][9][10][11]. It has certain advantages over previously used techniques, including its being a single-stage operation, with subsequent low morbidity and mortality and shorter length of hospitalization [13][14][15][16][17][18][19][20][21]. Technically, the ileum has a large and adequate vasculature and its diameter is almost the same as that of the esophagus.…”