Highlights
- •Free jejunal graft is a safe and effective method for pharyngo laryngo esophagectomy.
- •Early graft failure was observed in 6 patients (6.7%).
- •The cause of graft failure was congestion in all cases.
- •Postoperative anticoagulation therapy may be effective in preventing free jejunal graft necrosis.
Background
Pharyngo-esophageal reconstruction using free jejunal grafts has been widely used
for the treatment of locally advanced carcinomas of the hypopharynx and cervical esophagus.
However, the procedure is technically demanding and requires complex recontractions.
The aim of this study was to evaluate our institutional outcomes of reconstruction
using a free jejunal graft with vascular reconstruction in patients undergoing pharyngo
laryngo esophagectomy with a multidisciplinary surgical team.
Methods
There were 90 consecutive patients between October 2006 and February 2021. The mean
age was 64.6 ± 10.3 years, and there were 76 male patients. Of 90 patients, 49 underwent
preoperative chemotherapy and/or radiotherapy. Jejunal vessels were commonly anastomosed
to the common carotid artery and the internal jugular vein (77.8% and 92.2%, respectively).
Continuous intravenous infusion of heparin was used postoperatively.
Results
Necrosis of the graft was observed in 5 patients. An isolated revision of vein was
necessary in 1 patient. In all cases of graft failure, heparin was not used postoperatively.
On the other hand, among the patients without graft failure, heparin was used for
about two-thirds of the patients and was significantly different (0% vs. 66%, P = 0.01).
Conclusions
Free jejunal graft with vessel reconstruction is a safe and effective method for patients
undergoing pharyngo laryngo esophagectomy. The position for the prevention of kinking
as well anastomosis maneuver of vein is especially important. Moreover, early postoperative
anticoagulation is essential.
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Article info
Publication history
Published online: December 12, 2022
Accepted:
November 5,
2022
Received:
July 27,
2022
Footnotes
The first and second authors equally contributed.
Disclosure: There is no conflict of interest to be disclosed with respect to this article.
Data Access Statement: The data that support this article are available from the author upon reasonable request.
Author contributions: Study conception: T.F. Critical review and revision: All authors. Final approval of the article: All authors. Accountability for all aspects of the work: All authors.
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