Pharyngoesophageal reconstruction with the use of vascular anastomoses: Operative modifications and long-term prognosis

Abstract

Objective: Vascular surgical techniques have contributed to the success of pharyngoesophageal reconstruction. We report our methods and analysis of postoperative complications, quality of life, and long-term prognosis. Methods: Sixty-seven patients who underwent pharyngoesophageal reconstruction with use of vascular anastomoses comprised the study population. The operative procedures performed were free jejunal autograft transplantation in 54 patients, gastric pedicle placement with vascular anastomoses in 2, jejunal pedicle with vascular anastomoses in 4, colonic pedicle with vascular anastomoses in 4, free jejunal graft and gastric pedicle in 2, and free jejunal graft and jejunal pedicle in 1. The common carotid artery and internal jugular vein were primarily used as the recipient vessels. The period of postoperative observation ranged from 3 days to 145 months. Results: The postoperative complications noted were dehiscence in 7 patients, graft failure in 1, wound infection in 2, small bowel intussusception in 4, pneumonia in 2, disseminated intravascular coagulation in 1, and pancytopenia in 1. Revascularization was successful in all but 1 patient, and oral intake was achieved in 58. Persistent swallowing dysfunction was recognized in 4%. Speech restoration was achieved in 57% of the patients with esophageal speech in 7% and with an artificial larynx in 50%. In the long-term follow-up, 36% of our patients died of the primary disease, 9% died of other diseases, and 55% are alive. Conclusions: Esophageal reconstruction with the use of vascular anastomoses affords low morbidity and mortality. Postoperative swallowing and speech are satisfactory, and the function of the reconstructed esophagus is well preserved for as long as 10 years. (J Thoracic Cardiovasc Surg 1997; 113: 975-81)