Abstract
Summary Background Persisting anastomotic leakage after oncological esophagectomy is a severe problem associated with high mortality and morbidity. Unfortunately, treatment options with promising results are scarce, especially when conventional operative and endoscopic methods have failed. Due to limitation of oral intake and the need for artificial nutrition, quality of life (QOL) is reduced. Microvascular myocutaneous and cutaneous free flap (MFF) reconstruction could be a promising alternative. Methods This retrospective case series presents 7 patients treated between March 2017 and November 2020 at our surgical department, with persisting postoperative anastomotic leakage without further feasible treatment options. All patients received anastomotic MFF reconstruction; used flaps and important intraoperative factors like microvascular anastomosis were evaluated. Complications and patient contentment was assessed. Results The included 7 male patients had median age of 65.15 years (range: 48–75). MFF function was adequate in 6/7 patients, one flap necrosis was encountered. Whereas 5 patients initially had good results, surgical revision was performed in 1 patient to ensure graft function. Postoperative complications appeared in 6/7 patients. Mean duration of inpatient care was 63 days (range: 24–156). At the time of evaluation, 1 patient has died of his malignant disease. No more additional nutrition was needed in 3/6 patients with adequate graft function. Most patients reported improved QOL after MFF. Conclusion MFF free flap can be an alternative treatment option for patients with terminal esophagostomy after complicated oncological esophagus resection without further treatment options. The renewed ability of oral food intake results in a significant improvement of QOL.
Highlights
Esophageal cancer remains a rare diagnosis with limited prognosis in the Western world
Squamous cell carcinoma (SCC) is most frequently observed in Asia, whereas adenocarcinoma is more frequently observed in Europe, with a rising incidence compared to SCC in recent years [3]
All patients who received myocutaneous and cutaneous free flap (MFF) reconstruction were male; 6 patients initially received oncological esophagus resection because of SCC, 1 patient initially received hypopharyngeal resection after an SCC diagnosis followed by esophageal resection because of esophageal recurrence
Summary
Esophageal cancer remains a rare diagnosis with limited prognosis in the Western world. Published numbers of the Austrian national registry of esophageal resection compare well with results of renowned international centers, with major complications appearing in 21.7% and a mortality rate of 2.9% [1, 2]. Squamous cell carcinoma (SCC) and adenocarcinoma are the most frequently observed types of esophageal cancer, with 5.2 per 100,000 for SCC and 0.7 per 100,000 for adenocarcinoma. SCC is most frequently observed in Asia, whereas adenocarcinoma is more frequently observed in Europe, with a rising incidence compared to SCC in recent years [3]. Surgical esophagus resection is considered the gold standard treatment and the only potentially curative treatment option. Advanced tumors should receive neoadjuvant therapy to lower locoregional recurrence rates and to ensure R0 resection.
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