Clinical analysis of free jejunal-autograft for pharyngoesophageal reconstruction in patients with head and neck cancer.

Abstract

Total pharyngolaryngoesophagectomy (TPLE) is performed upon patients with advanced head and neck cancer. It is most frequently followed by pharyngoesophageal reconstruction with free jejunal autograft because there is a relatively low operative risk and it improves postoperative function of the reconstructed pharynx and esophagus. Whereas many reports have described early complications upon these procedures, few have documented late complications. Here we describe a retrospective analysis of early and late complications upon pharyngoesophageal reconstruction with free jejunal autograft following TPLE. The analysis was conducted by reviewing clinical charts of 114 consecutive patients (99 men, 15 women), who had undergone surgery in the Department of Head and Neck Surgery at Saitama Medical University International Medical Center from April 2007 to August 2015. The primary tumor sites was hypopharynx (97 patients), larynx (10), thyroid (3), cervical esophagus (2), or oropharynx (2). The mean age of the patients was 66.3 (ranging from 15 to 90) and the mean follow-up period was 29.2 months (ranging from 1 to 102). Postoperative early complications, including those that were minor or were not related to the graft, occurred in 27 patients (23.7 %), whereas late complications were seen in 18 patients (15.8 %). Previously reported late complications included anastomotic stenosis (7 cases), tracheal stomal stenosis (6), and intestinal obstruction (3). We also recorded rare complications such as a rupture of free jejunum aneurysm one month after the surgery, and partial necrosis of the autograft one year after the surgery. Statistical analyses failed to identify significant risk factor for either early or late complications. The late complications had a major impact on the quality of life of the patients, because many of the complications required an extended period of time for improvement. Thus, we concluded that perioperative precaution for these postoperative complications as well as long-term follow-up is essential when performing TPLE.