Reconstruction using free jejunal transfer after resection of cancer of the upper oesophagus.
BACKGROUND
Treatment of cancer of the upper part of the oesophagus is challenging. Even after intended curative treatment, less than half of the patients are alive after five years. This retrospective study evaluates all the patients who had the upper oesophagus reconstructed by use of a free jejunal transfer following cancer resection from February 2000 to May 2008 at the University Hospital of Aarhus.


METHODS
Twenty patients aged 46-75 years were included. In all 20 cases, the diagnosis was squamous cell carcinoma, T3 or T4. All patients suffered from severe dysphagia prior to surgery. The median follow-up time was 23 months at 31 January 2010.


RESULTS
No perioperative mortality was experienced. Thirteen patients are now dead; nine due to the cancer of the oesophagus and four due to other causes. The median survival time of the 13 diseased patients was 15.3 months. The seven patients who remain alive have a median survival time of 40.2 months. None of these patients have shown signs of recurrence of the oesophageal cancer. All the patients regained their capacity to swallow and thereby increased their quality of life. No complications were experienced in relation to the abdominal procedure of harvesting the jejunal transfer. Three patients developed a fistula and in one case this required minor surgery. Eight patients needed to have a dilatation procedure performed.


CONCLUSIONS
Reconstruction of the oesophagus with a free jejunal transfer is a suitable treatment for selected patients with cancer in the upper oesophagus.
Wallentin
Rikke Søjborg
RS
Laessøegade 4, 6000 Kolding, Denmark. rikke@wallentin.dk
Sørensen
Hanne Birke
HB
Bundgaard
Troels
T
Pahle
Einar
E
Nordsmark
Marianne
M
Pilegaard
Hans
H
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control; D003718:Denmark / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome