Free revascularized jejunal loop repair following total pharyngolaryngectomy for carcinoma of the hypopharynx: Report of 90 patients

Abstract

Ninety patients with carcinoma of the hypopharynx underwent pharyngolaryngectomy and reconstruction with a jejunal free autograft. Fifty-five patients had primary surgery and 35 salvage surgery for recurrence after radiotherapy. Following primary surgery 28 patients had postoperative radiotherapy and 27 did not. Complications occurred in 51 per cent of patients, the most common being necrosis of the jejunal graft (19 per cent); 12 per cent developed significant stenosis and 4 per cent died in the perioperative period. Eleven per cent of patients developed a fistula. The total number of complications diminished as the experience of the unit increased. Median follow-up was 4.9 years. Of patients treated with primary surgery, 48 per cent developed primary site recurrence (at 3 years) and 53 per cent neck node recurrence (at 5 years). The tumour-specific 5-year survival rate for all patients was 42 per cent. Following primary surgery 28 per cent survived for 5 years and after salvage surgery the rate was 59 per cent. Positive resection margins and extensive neck disease adversely affected survival (P = 0.02 and P = 0.001 respectively). The free revascularized jejunal graft is a safe and predictable method of repair following total pharyngolaryngectomy.

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

“…This may be due to a variety of factors such as abnormal motility, large volume or lack of muscular layers of the implant [3]. The technique for restoration of the voice by insertion of a prosthesis through a secondary tracheo-oesophageal puncture has replaced the previously described surgical shunt operations [15]. While the prosthesis technique is a standard procedure after laryngectomy, few reports are available in the present setting.…”

“…Two-stage operations such as the deltopectoral flap technique, colon interposition, reversed gastric tubes, local and regional skin flaps have to a large extent been replaced by one-stage procedures such as gastric pull-up or reconstruction with free fasciocutaneus microvascular transplants [2,3,4,5,6,7,8,9,10,11]. The use of free jejunal transplants has been popularized during the last decades and advocated by many surgeons [12,13,14,15,16,17,18]. The goal of this surgery is a low morbidity and mortality, short hospital stay and good functional results regarding swallowing and respiration.…”

Microvascular free tissue reconstruction following extirpation of head and neck tumour: experience towards an optimal outcome

“…The free jejunal graft is ideal for the reconstruction of a circumferential hypophyarngeal defect. [17][18][19][20] The surgical anatomy of these tissues is not complicated and with practice, it is not dif cult to raise these tissues for reconstruction of the appropriate defect. Familiarity with these common tissues is adequate for reconstruction of most defects in the head and neck region.…”

Composite reconstruction of hypopharynx and esophagus

“…Jejunal graft and radial forearm¯aps are the free tissues predominantly used. 2 Composite reconstructions are mainly indicated for synchronous (one-stage procedure) or metachronous (two-stage procedure) carcinomas of the head and neck and esophagus. 3±6 Other potential indications include: (i) cervical anastomotic recurrence after simple reconstruction for hypopharyngeal or esophageal carcinoma, (ii) sequels of associated esophageal and hypopharyngeal caustic injuries, and (iii) secondary reconstruction for the failure of a previous simple repair of an esophageal or hypopharyngeal defect.…”