title: Esophagectomy and gastric pull-up in patients with previous free jejunal transfer.
abstract: Several options exist for reconstruction after total esophagectomy in patients with esophageal carcinoma. However, the options for a major resection after previous head and neck surgery in these patients are extremely limited. The procedure performed in 2 patients requiring esophagectomy after resection for previous head and neck malignancies is described. Both patients underwent previous chemoradiation therapy and free jejunal transfer for hypopharyngeal squamous cell carcinoma. Esophagectomy and reconstruction with a cervical gastrojejunal anastomosis combined with deltopectoral flaps were performed after the diagnosis of esophageal disease. Soft tissue defects were closed with a modified deltopectoral flap using de-epithelization. The deltopectoral flap is effective not only for cutaneous resurfacing, but also to promote delayed wound healing after radiation therapy. This report demonstrates a useful multidisciplinary approach for resection and reconstruction in patients after a previous free jejunal transfer.
authors.affiliation: Department of Surgery, Jichi Medical University, Tochigi, Japan. hosoyo@jichi.ac.jp
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Hosoya
authors.forename: Shunji
authors.initials: S
authors.lastname: Sarukawa
authors.forename: Shiro
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Toru
authors.initials: T
authors.lastname: Zuiki
authors.forename: Masanobu
authors.initials: M
authors.lastname: Hyodo
authors.forename: Koichi
authors.initials: K
authors.lastname: Abe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishino
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Alan T
authors.initials: AT
authors.lastname: Lefor
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yasuda
mesh_terms: D000714:Anastomosis, Surgical; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000628:therapy; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D010610:Pharyngeal Neoplasms / Q000473:pathology / Q000628:therapy; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D018570:Risk Assessment; D013270:Stomach / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome