The Use of Short Segment Free Jejunal Transfer as Salvage Surgery for Cervical Esophageal and Hypopharyngeal Cancer

Shuhei Mayanagi,Masahiro Nakagawa,Tetsuro Onitsuka,Yuko Kitagawa,Yasuhiro Tsubosa,Hiroshi Sato

doi:10.1007/s00268-013-2229-9

Shuhei Mayanagi, Masahiro Nakagawa + Show 4 more

Open Access

https://doi.org/10.1007/s00268-013-2229-9

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Abstract

BackgroundSalvage surgery after definitive chemoradiotherapy for cervical esophageal cancer and hypopharyngeal cancer remains a challenge because of the high rate of complications. The purpose of this study was to evaluate the safety and efficacy of free jejunal transfer as salvage surgery for cervical esophageal cancer and hypopharyngeal cancer after definitive chemoradiotherapy.MethodsWe enrolled eight patients with cervical esophageal cancer and 11 patients with hypopharyngeal cancer who underwent free jejunal transfer as salvage surgery following radiotherapy or chemoradiotherapy. In this study, we reviewed the surgical procedures, perioperative complications, and survival rates.ResultsThe median duration of surgery was 514 min, and the median blood loss was 439 ml. In surgical procedures, the recipient vessels for the anastomosis of the free jejunum consisted of one artery and one vein (63 %), one artery and two veins (5 %), and two arteries and two veins (31 %). The postoperative morbidity rate was 57.9 % (11 patients), with six cases of partial necrosis of the tracheal margin and no cases of graft necrosis or postoperative in-hospital death. The overall 5-year survival rate after surgery was 58.1 %.ConclusionsOur findings suggest that with careful attention to the potential development of necrosis of the tracheal margin, pharyngolaryngoesophagectomy and free jejunal transfer can be safely performed, even in patients who received radiotherapy or chemoradiotherapy.

Highlights

Cervical esophageal cancer is relatively uncommon, accounting for less than 5% of all esophageal cancers [1]
Our findings suggest that with careful attention to the potential development of necrosis of the tracheal margin, pharyngolaryngoesophagectomy and free jejunal transfer can be safely performed, even in patients who received radiotherapy or chemoradiotherapy
The patients who underwent total pharyngolaryngoesophagectomy (TPLE) and free jejunal transfer (FJT) had a median age of 65 years

Summary

Introduction

Cervical esophageal cancer is relatively uncommon, accounting for less than 5% of all esophageal cancers [1]. Hypopharyngeal cancer accounts for approximately 6 % of all head and neck cancers [2]. Chemoradiotherapy (CRT) has been accepted as the standard initial therapy for cervical esophageal and hypopharyngeal cancers [3]. Patients often choose definitive CRT as the initial treatment. When a patient requires additional treatment for recurrent or residual lesions, salvage surgery is the only treatment for a cure or long-term disease control. Salvage surgery after definitive chemoradiotherapy for cervical esophageal cancer and hypopharyngeal cancer remains a challenge because of the high rate of complications. The purpose of this study was to evaluate the safety and efficacy of free jejunal transfer as salvage surgery for cervical esophageal cancer and hypopharyngeal cancer after definitive chemoradiotherapy

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