Functional results following pharyngolaryngooesophagectomy with free jejunal graft reconstruction.

Abstract

A free jejunal graft is used for reconstruction following pharyngolaryngooesophagectomy, due to the relative ease of harvesting, low donor site morbidity and a lumen diameter compatible with that of the oesophagus. Our aim is to evaluate the postoperative outcome and functional results of the procedure. Retrospective analysis of 20 consecutive patients, with a mean age of 62.5 years (range 48--76), who underwent free jejunal reconstruction following pharyngolaryngooesophagectomy for laryngeal malignancy. Surgery was performed secondary to radiotherapy or as the main stem of treatment. The functional results were assessed at 6 months and 1 year and correlated with postoperative morbidity. Chi-square test was used for statistical significance and Kaplan--Meyer to estimate survival. There were six transient leaks and six cases with anastomotic stricture. There was no morbidity associated with the donor site and the perioperative mortality (30 days) was zero. At 6 months, 13 (87%) out of the 15 patients alive had satisfactory speech and 11 (78%) had satisfactory swallowing. At 1 year, 11 patients were alive and maintained a satisfactory speech, while nine (81%) of them were eating well. The incidence of leaks, strictures, or the moment of radiotherapy has no influence on the functional outcome. The 1- and 3-year survival rates were 52.3 and 33.2%, respectively. A free jejunal graft reconstruction is technically demanding, but provides a near-physiologic swallowing mechanism, avoiding the complications of a gastric pull-up procedure. Functional results are good and justify the procedure despite the relatively high co-morbidity.