Usefulness of the Clavien–Dindo Classification in Understanding the Limitations and Indications of Larynx-preserving Esophageal Reconstruction

Abstract

Background:The Clavien–Dindo (CD) classification is used to evaluate the severity of surgical complications. However, its usefulness in esophageal reconstruction has not been reported. To address this, this case series study used the CD classification to evaluate the complications after cervical esophageal reconstruction with free jejunum transfer or supercharged pedicled intestinal transfer.Methods:All consecutive patients who underwent esophageal cancer surgery with larynx-preserving free jejunum or pedicled ileocolic transfer in June 2012–December 2015 were identified. The postoperative complications were classified using the CD classification.Results:In total, 22 patients (20 men and 2 women; mean age, 63.3 years) underwent esophageal cancer reconstruction with larynx-preserving free jejunum transfer (n = 9) and supercharged pedicled intestinal transfer (n = 13). Seven patients underwent prophylactic tracheotomy. Four patients underwent emergent tracheotomy 1 or 5 days after surgery. The most frequent complication was recurrent nerve paralysis (RNP) (n = 8). Of these 8 RNP cases, 6 and 2 were classified as CD I and III complications, respectively. Pneumonia was the next most common complication (n = 7). Of these 7 pneumonia cases, 5 and 2 were classified as CD II and III, respectively. There were 2 cases of intestinal anastomosis leakage (CD II and III). On average, patients were able to start oral alimentation 15.1 (9–35) days after surgery.Conclusions:Our analysis with the CD classification suggested that vascularized free jejunum transfer or supercharge-drainage pedicled ileocolic transfer prevents postoperative intestinal anastomosis leakage and that prophylactic tracheotomy is especially indicated in cases with significant surgical damage in the cervical region.

A Novel Tube-Drainage Technique of Negative Pressure Wound Therapy for Fistulae after Reconstructive Surgery

“…11 Similarly, a review and a case–control study showed that compared with primary closure, which associates with fistula formation rates of 20–50%, vascularized tissue transfer reduces fistula formation to 15–20%. 12,13 However, if a fistula does develop and flap surgery is performed again to repair it, the risk of complications increases: these complications include infection, donor-site mobility, and flap necrosis, as well as formation of another fistula or relapse of the original fistula.…”

Applying the Microvascular Anastomotic Coupler Device to End-to-side Venous Anastomosis in Reconstructive Surgery

“…Free flap transfer is an important procedure in head and neck reconstruction. Many factors dictate the success of this procedure, including flap selection, vascular anastomosis, the flap-suturing method, various considerations made to ensure tracheal and swallowing functions, and postoperative management 10–13 Of these factors, microsurgical vascular anastomosis is particularly crucial. However, it should be emphasized here that successful vascular anastomosis does not mean successful surgery: the surgery is successful only if the flap fully restores the lost functions and roles.…”

“…This classification is graded I (deviations from the normal postoperative course that does not require intervention), II (deviations requiring pharmacological interventions), III (deviations requiring surgical or invasive treatment), IV (life-threatening deviations), and V (death). 9 In our study, the CD classification was expressed as CDI or CDII and CDIII or higher. The frequency of CDIII or higher cases whose complication was venous trouble that led to flap congestion and salvage surgery was also recorded.…”

Long-Term Oncologic Outcomes, Opioid Use, and Complications after Esophageal Cancer Surgery

“…This association is an important issue with regard to esophageal cancer surgery. Recent studies have reported that the Clavien-Dindo classification provides an effective assessment of complications after esophageal cancer surgery [ 17 ]. Postoperative complications using this classification were found to have an impact on patient OS or RFS in two previous studies [ 7 , 8 ], and our findings support the findings of these studies.…”