Standardization of free jejunum transfer after total pharyngolaryngoesophagectomy.
OBJECTIVE
Our latest free jejunum transfer procedure was reviewed and compared with previous procedures to standardize the operation.


METHODS
This was a retrospective study of 269 patients who had undergone total pharyngolaryngoesophagectomy and free jejunum transfer from 1992 through 2004. The patients were divided into two groups: a late group, in which surgery was performed with our latest standard procedure from 2000 through 2004, and an early group, in which various procedures had been used from 1992 through 1999. Surgical times, postoperative progress, and complications were evaluated.


RESULTS
The mean surgical time was shortened from 3 hours 25 minutes in the early group to 3 hours 9 minutes in the late group, and ischemic time was shortened from 2 hours 44 minutes to 2 hours 20 minutes. For recipient vessels, branches of the external carotid artery and the internal jugular vein were more often used in the late group. Length of hospitalization decreased from 31.7 days in the early group to 24.4 days in the late group, although the start of drinking was similar (15.4 days versus 12.1 days). The rates of complications were significantly reduced in the late group, particularly those associated with the enteric anastomosis such as minor leakage (18.2-5.2%) and stenosis (17.6-3.0%).


CONCLUSIONS
Our latest method of free jejunum transfer reconstruction has become reliable and expeditious through simple and stable minor revisions of procedures.
Sarukawa
Shunji
S
Division of Plastic and Reconstructive Surgery and Head and Neck Surgery, National Cancer Center Hospital, East, Chiba, Japan. ssarukaw@east.ncc.go.jp
Sakuraba
Minoru
M
Kimata
Yoshihiro
Y
Yasumura
Tsuneo
T
Uchiyama
Kiyotaka
K
Hishinuma
Shigeyuki
S
Nakatsuka
Takashi
T
Hayashi
Ryuichi
R
Ebihara
Satoshi
S
Harii
Kiyonori
K
D016629:Esophagectomy / Q000379:methods*; D004944:Esophagoplasty / Q000379:methods; D005260:Female; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010611:Pharyngectomy / Q000379:methods*; D011182:Postoperative Care; D011183:Postoperative Complications; D012189:Retrospective Studies