Free Jejunal Graft for Esophageal Reconstruction Using End-to-Side Vascular Anastomosis and Extended Pharyngo-Jejunostomy

摘要

PatientsOperationStatistical AnalysisResultsPharyngo-esophageal reconstruction using free jejunal grafts (FJGs) has been widely used, but the procedure is technically demanding and requires the involvement of multiple departments. We performed simplified reconstruction with FJGs using end-to-side vascular anastomosis and extended pharyngo-jejunostomy.MethodsThe jejunal artery and vein were anastomosed to the neck vessels in an end-to-side fashion without microvascular anastomosis. Pharyngo-jejunostomy with extended end-to-end anastomosis was performed to reduce size mismatch. We retrospectively analyzed the medical records of 32 patients diagnosed with pharyngeal, esophageal, or pyriform sinus cancer who received a FJG.ResultsThe mean age was 61.5 ± 9.4 years, and there were 25 male patients. Jejunal vessels were commonly anastomosed to the right common carotid artery and the right internal jugular vein (22, 68.8%). The mean ischemic times of the FJG and carotid artery clamping time were 46.5 ± 8.1 and 15.8 ± 4.4 minutes, respectively. During the procedure, 3 patients suffered from inadequate reperfusion of the FJG requiring removal of the initial graft and replacement with another FJG. There were no neurologic complications, postoperative deaths, or adverse events directly related to FJG except for leakage of the pharyngo-jejunostomy site in 1 patient, which was primarily repaired. During the follow-up period, 5 patients (15.6%) suffered from dysphagia, but only 3 patients had evidence of anastomotic strictures at the jejuno-esophagostomy site. Thirteen patients (40.6%) received postoperative adjuvant radiotherapy.ConclusionsOur technique of FJG with end-to-side vascular anastomosis and extended pharyngo-jejunostomy is simple and safe.CTSNet classification:7Although chemoradiation therapy is widely used in the treatment of locally advanced carcinomas of the hypopharynx and cervical esophagus, surgical treatment also plays an important role. Many of these patients suffer from dysphagia, and surgical treatment can improve swallowing function and quality of life. However, surgical resection of the hypopharynx and cervical esophagus results in pharyngo-esophageal defects. In the search for the ideal technique to repair pharyngo-esophageal defects several procedures have been developed and described. Various myocutaneous flaps, including the radial forearm flap, the pectoralis major myocutaneous flap, and the rectus abdominalis free flap have been widely used for many years. However, these methods all have drawbacks such as a long operation time and a high rate of flap necrosis.Pharyngo-esophageal reconstruction with free jejunal graft (FJG) is a good alternative to these procedures and was first described in 1959 by Seidenberg and colleagues [