200 freie Jejunumtransplantationen: Lohnt der große operative Aufwand?*

Abstract

From 1983 to 1992, 216 free jejunal transplants were performed after resection of malignant tumours for reconstructing the upper oesophageal tract. In two patients reconstruction was performed secondarily and in four cases within the framework of recurrence treatment. In 25 cases the jejunal transplant was sewn in tubular form to the circular insert of the hypopharynx, whereas in the remaining 188 cases the jejunum transplant was sewn as patch. A jejunum transplant was most frequently employed in the tonsillar region (n = 75). Reconstruction of the body of the tongue was performed in 42 cases and of the hypopharynx in 29 cases. Of the 213 patients treated, 175 were irradiated postoperatively. The most severe complications were in 5 cases death from the sequels of the operating, abdominal complications in 15 cases and complete loss of the transplant in 22 cases. Protracted inability to swallow occurred in 15 cases and pneumonia in 16 patients. The five-year survival probability was 39% for the 42 patients suffering from carcinomas of the oral cavity, 53% for the 90 patients with oropharyngeal carcinoma in stage III and 33% in stage IV, as well as 40% with the 29 patients suffering from hypopharyngeal carcinomas. An essential advantage of the free jejunum transplants were the excellent functional reconstruction results. This is demonstrated by examples of various cases. Since the number of treated patients is still too low, it is at present not yet possible to compare this approach with other therapeutic concepts, such as enoral laser surgery resection or radiochemotherapy.