title: Results of gastric interposition for reconstruction of the pharyngoesophagus.
abstract: BACKGROUND
  Free jejunal transfer has become the standard technique for reconstruction of the proximal pharynx and hypopharynx. Gastric tube interposition is an effective alternative when resection extends below the thoracic inlet. This study was done to determine current indications, review morbidity and mortality rates, and to define clinical and pathologic determinants of survival associated with this procedure.
  
  
  METHODS
  We reviewed the records of 32 patients who underwent gastric tube interposition for reconstruction of the pharyngoesophagus from 1987 to 1997.
  
  
  RESULTS
  The overall complication rate was 50%. Complications were more frequent in the reoperative group (22% vs 66%, P < .05). The overall fistula rate was 31%. The overall mortality rate was 12%. Ultimately, 71% of patients resumed oral feedings. The 5-year actuarial survival rate was 22%. Unfavorable prognostic factors associated with significantly reduced survival (P < . 05) included margin positive resection, positive lymph node involvement, and operations done for recurrent tumor
  
  
  CONCLUSIONS
  Reconstruction of the pharyngoesophagus with gastric tube interposition is indicated for primary tumors of the hypopharynx and cervical esophagus with inferior extension below the thoracic inlet and recurrent tumors or benign strictures in which free jejunal transfer is not feasible or has failed. It can be done with acceptable morbidity and mortality and provides reasonable expectations for long-term survival and resumption of oral intake.
authors.affiliation: Department of Surgery, Northwestern University Medical School, Chicago, Ill 60611, USA.
authors.forename: M W
authors.initials: MW
authors.lastname: Sullivan
authors.forename: M S
authors.initials: MS
authors.lastname: Talamonti
authors.forename: K
authors.initials: K
authors.lastname: Sithanandam
authors.forename: A W
authors.initials: AW
authors.lastname: Joob
authors.forename: H J
authors.initials: HJ
authors.lastname: Pelzer
authors.forename: R J
authors.initials: RJ
authors.lastname: Joehl
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010610:Pharyngeal Neoplasms / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome