Reconstruction with free jejuna flap for the defect after removal of hypopharyngeal and cervical esophageal caneer: clinical analyses of 103 cases

Abstract

Objective: To report our experience in reconstruction with free jejunal flap for circumferential defect following resection of hypopharygeal and cervical esophageal carcinoma. Methods: A retrospective analysis was conducted to evaluate the outcomes of reconstruction with free jejunal flaps for circumferential defects in 103 patients treated from Aug 2008 to Mar 2015. Among them, 84 were hypopharyngeal carcinoma and 19 were cervical esophageal carcinoma; 31 patients had total pharyngolaryngectomy, 70 had total pharyngolaryngectomy and cervical esophagectomy and 2 had laryngeal preservation. All patients underwent bilateral neck dissection and 84 underwent retropharyngeal lymph node dissection. Results: The 3 year overall survival rate was 51.6% and disease-specific survival rate was 50%. The 5 year overall survival rate was 39.1%. No in-hospital death, one patient had unsalvageable flap failure and underwent second reconstruction with free jejunal flap. The success rate for the free jejunal flaps was 99% (102/103). Pharyngocutanous fistula occurred in 3 patients and all healed with conservative treatment. Satisfactory oral intake was achieved in all patients. Conclusions: Oncological and functional outcomes of reconstruction with free jejunal flap for circumferential defects of hypopharynx and cervical esophagus were satisfying. Multidisciplinary cooperation is helpful to improve surgical success rate. Free jejunal flap is an ideal method for reconstruction of circumferential hypopharyngeal and cervical esophageal defects after removal of tumor.