Clinical Article

Comparison of the outcomes of free jejunal flap reconstructions of pharyngoesophageal defects in hypopharyngeal cancer and corrosive injury patients

Mu-Han Hsieh MD

Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan

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Yun-Tai Yang MD, FRACS,

Yun-Tai Yang MD, FRACS

Auckland Regional Plastic Reconstructive and Hand Surgery, Middlemore Hospital, Auckland, New Zealand

These two authors contributed equally to this work.

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Yueh-Ju Tsai MD,

Yueh-Ju Tsai MD

Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan

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Yur-Ren Kuo MD, PhD, FACS,

Corresponding Author

Yur-Ren Kuo MD, PhD, FACS

[email protected]

Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

These two authors contributed equally to this work.

Correspondence Pao-Yuan Lin, MD, Division of Plastic and Reconstructive Surgery,

Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Song District,

Kaohsiung 83301, Taiwan Email: [email protected] or Yur-Ren Kuo, MD, PhD, FACS, Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital,

Kaohsiung, Taiwan Email: [email protected]

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Pao-Yuan Lin MD,

Corresponding Author

Pao-Yuan Lin MD

[email protected]

Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan

These two authors contributed equally to this work.

Correspondence Pao-Yuan Lin, MD, Division of Plastic and Reconstructive Surgery,

Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Song District,

Kaohsiung 83301, Taiwan Email: [email protected] or Yur-Ren Kuo, MD, PhD, FACS, Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital,

Kaohsiung, Taiwan Email: [email protected]

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Mu-Han Hsieh MD,

Mu-Han Hsieh MD

Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan

Search for more papers by this author

Yun-Tai Yang MD, FRACS,

Yun-Tai Yang MD, FRACS

Auckland Regional Plastic Reconstructive and Hand Surgery, Middlemore Hospital, Auckland, New Zealand

These two authors contributed equally to this work.

Search for more papers by this author

Yueh-Ju Tsai MD,

Yueh-Ju Tsai MD

Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan

Search for more papers by this author

Yur-Ren Kuo MD, PhD, FACS,

Corresponding Author

Yur-Ren Kuo MD, PhD, FACS

[email protected]

Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

These two authors contributed equally to this work.

Correspondence Pao-Yuan Lin, MD, Division of Plastic and Reconstructive Surgery,

Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Song District,

Kaohsiung 83301, Taiwan Email: [email protected] or Yur-Ren Kuo, MD, PhD, FACS, Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital,

Kaohsiung, Taiwan Email: [email protected]

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Pao-Yuan Lin MD,

Corresponding Author

Pao-Yuan Lin MD

[email protected]

Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan

These two authors contributed equally to this work.

Correspondence Pao-Yuan Lin, MD, Division of Plastic and Reconstructive Surgery,

Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Song District,

Kaohsiung 83301, Taiwan Email: [email protected] or Yur-Ren Kuo, MD, PhD, FACS, Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital,

Kaohsiung, Taiwan Email: [email protected]

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First published: 23 November 2016

https://doi.org/10.1002/micr.30135

Citations: 16

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Abstract

Introduction

Free jejunal flap is one of the optimal choices for restoring upper digestive tract. The purpose of this study was to introduce the treatment strategies and to compare the outcomes of free jejunal flap for pharyngoesophageal reconstruction between hypopharyngeal cancer and chemical corrosive injured esophagus.

Methods

From 2001 to 2012, patients who had been received esophageal reconstruction by free jejunal flap for pharyngoesophageal defect were divided into squamous cell carcinoma (SCC) group and corrosive chemical injury (CCI) group. All data on outcomes and complications including relevant radiographic investigations were collected retrospectively.

Results

Sixteen patients were in SCC group and 9 patients in CCI group underwent free jejunal flap reconstruction. Two cases of flap failure were noted in SCC group, and no flap failure in CCI group—the total failure rate was 8% (2/25 patients). In SCC group, 5 of 16 patients (31.3%) developed fistula; however, no fistula in CCI group. One patient in SCC group and 3 patients in CCI group developed esophageal strictures. Other than early stricture (stricture <1 year) which reached significant difference, all of other complications were not statistically significant between two groups. The average follow-up time was 42 months.

Conclusions

Postoperative early stricture but lower fistula occurrence is expected in patients with corrosively injured esophagi. This helpful preliminary findings could not only early-check complication, but also better explanation and prepare were taken placed before operation.

References

Coleman, J. J. (1989). Reconstruction of the pharynx after resection for cancer. A comparison of methods. Annals of Surgery, 209, 554–560; discussion 561.
10.1097/00000658-198905000-00007
PubMed Web of Science® Google Scholar
Wu, M. H, Tseng, Y. L., Lin, M. Y., & Lai, W. W. (2001). Esophageal reconstruction for hypopharyngoesophageal strictures after corrosive injury. European Journal of Cardiothoracic Surgery, 19, 400–405.
10.1016/S1010-7940(01)00614-5
CAS PubMed Web of Science® Google Scholar
Anthony, J. P., Singer, M. I., Deschler, D. G., Dougherty, T., Reed, C. G., & Kaplan, M. J. (1994). Long-term functional results after pharyngoesophageal reconstruction with the radial forearm free flap. American Journal of Surgery, 168, 441–445.
10.1016/S0002-9610(05)80095-9
CAS PubMed Web of Science® Google Scholar
Piazza, C., Taglietti, V., & Nicolai, P. (2012). Reconstructive options after total laryngectomy with subtotal or circumferential hypopharyngectomy and cervical esophagectomy. Current Opinion in Otolaryngology Head Neck Surgery, 20, 77–88.
10.1097/MOO.0b013e328350a5cc
PubMed Web of Science® Google Scholar
Chen, H. C., Rampazzo, A., Gharb, B. B., Wong, M. T. C., Mardini, S., … Chen, H. Y. (2008). Motility differences in free colon and free jejunum flaps for reconstruction of the cervical esophagus. Plastics and Reconstructive Surgery, 122, 1410–1416.
10.1097/PRS.0b013e31818820f4
CAS PubMed Web of Science® Google Scholar
Tan, N. C., Lin, P. Y., Kuo, P. J., Tsai, Y. T., Chen, Y. C., Nguyen, K. T., … Kuo, Y. R. (2014). An objective comparison regarding rate of fistula and stricture among anterolateral thigh, radial forearm, and jejunal free tissue transfers in circumferential pharyngo-esophageal reconstruction. Microsurgery, 35, 345–349.
10.1002/micr.22359
PubMed Web of Science® Google Scholar
Azizzadeh, B., Yafai, S., Rawnsley, J. D., Abemayor, E., Sercarz, J. A., Calcaterra, T. C., & Berke, G. S. (2001). Radial forearm free flap pharyngoesophageal reconstruction. Laryngoscope, 111, 807–810.
10.1097/00005537-200105000-00010
CAS PubMed Web of Science® Google Scholar
Moradi, P., Glass, G. E., Atherton, D. D., Eccles, S., Coffey, M., Majithia, A., … Speirs, A. J. D. (2010). Reconstruction of pharyngolaryngectomy defects using the jejunal free flap: A 10-year experience from a single reconstructive center. Plastics and Reconstructive Surgery, 126, 1960–1966.
10.1097/PRS.0b013e3181f446a6
CAS PubMed Web of Science® Google Scholar
Yu, P. H., Hanasono, M. M., Skoracki, R. J., Baumann, D. P., Lewin, J. S., Weber, R. S., … Robb, G. L. (2010). Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy. Cancer, 116, 1718–1724.
10.1002/cncr.24947
CAS PubMed Web of Science® Google Scholar
Hong, J. W., Jeong, H. S., Lew, D. H., Roh, T. S., Tark, K. C., Choi, E. C., … Lee, W. J. (2009). Hypopharyngeal reconstruction using remnant narrow pharyngeal wall as omega-shaped radial forearm free flap. Journal of Craniofacial Surgery, 20, 1334–1340.
10.1097/SCS.0b013e3181ae66a9
PubMed Web of Science® Google Scholar
Dionyssopoulos, A., Odobescu, A., Foroughi, Y., Harris, P., Karagergou, E., Guertin, L., … Ferraro, P. (2012). Monitoring buried jejunum free flaps with a sentinel: A retrospective study of 20 cases. Laryngoscope, 122, 519–522.
10.1002/lary.22382
CAS PubMed Web of Science® Google Scholar
Feng, G., Yang, W. G., Chen, S. H. T., Chu, Y. M., Tsai, L. M., Chang, T. M., Mardini, S., & Chen, H. C. (2006). Periodic alterations of jejunal mucosa morphology following free microvascular transfer for pharyngoesophageal reconstruction. Journal of Plastics and Reconstructive Aesthetic Surgery, 59, 1312–1317.
10.1016/j.bjps.2006.05.014
PubMed Web of Science® Google Scholar
Yu, P., Lewin, J. S., Reece, G. P., & Robb, G. L. (2006). Comparison of clinical and functional outcomes and hospital costs following pharyngoesophageal reconstruction with the anterolateral thigh free flap versus the jejunal flap. Plastics and Reconstructive Surgery, 117, 968–974.
10.1097/01.prs.0000200622.13312.d3
CAS PubMed Web of Science® Google Scholar
McCarthy, C. M., Kraus, D. H., & Cordeiro, P. G. (2005). Tracheostomal and cervical esophageal reconstruction with combined deltopectoral flap and microvascular free jejunal transfer after central neck exenteration. Plastics and Reconstructive Surgery, 115, 1304–1310; discussion 1311–1313.
10.1097/01.PRS.0000156916.82294.98
CAS PubMed Web of Science® Google Scholar
Schultz-Coulon, H. J. (2001). Jejunum interposition after cervical esophageal resection. Disease of the Esophagus, 14, 13–16.
10.1111/j.1442-2050.2001.00144.x
CAS PubMed Web of Science® Google Scholar
Disa, J. J., Pusic, A. L., Hidalgo, D. A., & Cordeiro, P. G. (2003). Microvascular reconstruction of hypopharynx: Defect classification, treatment algorithm and function outcome based on 165 consercutive cases. Plastics and Reconstructive Surgery, 111, 652–660.
10.1097/01.PRS.0000041987.53831.23
PubMed Web of Science® Google Scholar
Virtaniemi, J. A., Kumpulainen, E. J., Hirvikoski, P. P., Johansson, R. T., & Kosma, V. M. (2001). The incidence and etiology of postlaryngectomy pharyngocutaneous fistulae. Head and Neck, 23, 29–33.
10.1002/1097-0347(200101)23:1<29::AID-HED5>3.0.CO;2-P
CAS PubMed Web of Science® Google Scholar

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Volume37, Issue6

September 2017

Pages 552-557

Comparison of the outcomes of free jejunal flap reconstructions of pharyngoesophageal defects in hypopharyngeal cancer and corrosive injury patients

Abstract

Introduction

Methods

Results

Conclusions

References

Citing Literature

References

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Comparison of the outcomes of free jejunal flap reconstructions of pharyngoesophageal defects in hypopharyngeal cancer and corrosive injury patients

Abstract

Introduction

Methods

Results

Conclusions

References

Citing Literature

References

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