title: Larynx-preserving esophagectomy and jejunal transfer for cervical esophageal carcinoma.
abstract: OBJECTIVE
  To examine the efficacy and safety of free jejunal transfer after larynx-preserving esophagectomy in patients with cervical esophageal carcinoma, especially with a high tumor involving the hypopharynx.
  
  
  METHODS
  A retrospective analysis of patients with cervical esophageal carcinoma who underwent free jejunal transfer after larynx-preserving esophagectomy.
  
  
  METHODS
  The subjects were 32 patients who underwent larynx-preserving cervical esophagectomy and microvascular jejunal transfer. Fifteen patients had a high cervical esophageal carcinoma that involved the hypopharynx (high-tumor group), and 17 patients had a low cervical esophageal carcinoma that did not involve the hypopharynx (low-tumor group). For each group, mortality, morbidity (anastomotic leakage, wound infection, stricture, and recurrent laryngeal nerve palsy), functional outcomes (time to start oral intake, achieve complete oral intake, decannulation, and rate of larynx preservation), and oncologic outcomes (survival and local control rate) were reviewed and compared.
  
  
  RESULTS
  No perioperative deaths occurred in either group. The incidence of postoperative complications did not differ between the groups. Oral intake started significantly later in the high-tumor group (14.9 days) than in the low-tumor group (10.4 days), but all patients in the high-tumor group could finally achieve oral intake without aspiration. Decannulation was possible in patients who underwent tracheostomy, and laryngeal function was completely preserved in the high-tumor group. Both survival and local control rate did not differ between the groups.
  
  
  CONCLUSIONS
  Free jejunal grafts in larynx-preserving surgery can be performed safely and reliably in patients with low cervical esophageal carcinomas and in selected patients with high tumors involving the hypopharynx.
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Chiba, Japan. kadohide@qent.med.kyushu-u.ac.jp
authors.forename: Hideki
authors.initials: H
authors.lastname: Kadota
authors.forename: Minoru
authors.initials: M
authors.lastname: Sakuraba
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kimata
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Hayashi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ebihara
authors.forename: Hoichi
authors.initials: H
authors.lastname: Kato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D007830:Larynx / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome