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Functional long-term outcome of a free jejunal transplant reconstruction following chemoradiotherapy and radical resection for hypopharyngeal and proximal oesophageal carcinoma

Journal article
Authors Henrik Bergquist
Hasse Ejnell
Ingemar Fogdestam
Hans Mark
Claes Mercke
Lars Lundell
Magnus Ruth
Published in Digestive surgery
Issue 21
Pages 426-433
Publication year 2004
Published at Institute of Selected Clinical Sciences, Department of Oncology
Institute of Surgical Sciences, Department of Plastic Surgery
Institute of Selected Clinical Sciences, Department of Otolaryngology
Institute of Surgical Sciences, Department of Surgery
Pages 426-433
Language en
Keywords Oesophageal cancer, free jejunal reconstruction, microvascular surgery, voice prosthesis, quality of life
Subject categories Otorhinolaryngology

Abstract

BACKGROUND/AIMS: To evaluate the functional outcome of a reconstruction by a free vascularized jejunal transplant combined with a voice prosthesis after chemoradiotherapy and surgery for proximal oesophageal or hypopharyngeal cancer. METHODS: Seven patients (6 men, mean age 52 years, range 28-70) with squamous cell cancer in the proximal oesophagus (n = 6) or the hypopharynx received preoperative chemoradiotherapy (40.8 Gy, cisplatinum and 5-FU) followed by a circumferential pharyngolaryngectomy and resection of the proximal oesophagus. A single-stage reconstruction was carried out with a free jejunal transplant using a microsurgical technique. A tracheojejunal puncture and insertion of a voice prosthesis (Provox I) was performed after 3 months in suitable cases. RESULTS: All operations had a per- and postoperative uneventful course. Five patients were alive after a mean follow-up time of 5 years and 7 months after surgery (range 3 years 4 months to 7 years 10 months), while 2 patients died from metastases within 2 years after surgery. Postoperative examination showed histopathological down-staging in all cases. Relief of dysphagia was achieved in most cases. Good or average speech was recorded in 3 patients. CONCLUSION: Reconstruction after radical resection for proximal oesophageal and hypopharyngeal cancer can be carried out with low mortality, acceptable morbidity and a promising functional outcome.

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