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01-09-2017 | Original Scientific Report

Clinical Assessment of Reconstruction Involving Gastric Pull-Up Combined with Free Jejunal Graft After Total Pharyngolaryngoesophagectomy

Authors: Hiroshi Miyata, Keijiro Sugimura, Masaaki Motoori, Yoshiyuki Fujiwara, Takeshi Omori, Masahiro Mun, Masayuki Ohue, Masayoshi Yasui, Norikatsu Miyoshi, Takashi Fujii, Hiroki Tajima, Tomoyuki Kurita, Masahiko Yano

Published in: World Journal of Surgery | Issue 9/2017

Abstract

Background

Total pharyngolaryngoesophagectomy (PLE) is used as a curative treatment for synchronous laryngopharyngeal and thoracic esophageal cancer or for multiple cancers in the cervical and thoracic esophagus. Gastric pull-up is commonly used after PLE, but postoperative complications are common. The present study evaluated these procedures in patients with esophageal cancer.

Methods

Fourteen patients (7 with synchronous pharyngeal and thoracic esophageal cancer, 4 with synchronous cervical and thoracic esophageal cancer, and 3 with cervicothoracic esophageal cancer) underwent reconstructive surgery after PLE involving gastric pull-up combined with free jejunal graft between 2004 and 2015.

Results

Esophagectomy via right thoracotomy was performed in 9 patients, and transhiatal esophagectomy was used in 5. The posterior mediastinal route was used in 13 patients, excluding one patient with early gastric cancer. Interposition of a free jejunal graft included microvascular anastomosis using two arteries and two veins in all patients. Anastomotic leakage and graft necrosis did not occur in any of the 14 patients who underwent the above surgical procedures. Tracheal ischemia close to the tracheostomy orifice occurred in 4 patients (28.6%), but none of these patients developed pneumonia. No hospital deaths were recorded.

Conclusions

The results indicate that gastric pull-up combined with free jejunal graft is a feasible reconstructive surgery after PLE. This procedure is a promising treatment strategy for synchronous pharyngeal and thoracic esophageal cancer or multiple cancers in the cervical and thoracic esophagus. Larger series are needed to show the distinct advantages of this procedure in comparison with conventional methods of reconstruction after PLE.

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Title: Clinical Assessment of Reconstruction Involving Gastric Pull-Up Combined with Free Jejunal Graft After Total Pharyngolaryngoesophagectomy
Authors: Hiroshi Miyata
Keijiro Sugimura
Masaaki Motoori
Yoshiyuki Fujiwara
Takeshi Omori
Masahiro Mun
Masayuki Ohue
Masayoshi Yasui
Norikatsu Miyoshi
Takashi Fujii
Hiroki Tajima
Tomoyuki Kurita
Masahiko Yano
Publication date: 01-09-2017
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 9/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-3948-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical Assessment of Reconstruction Involving Gastric Pull-Up Combined with Free Jejunal Graft After Total Pharyngolaryngoesophagectomy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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