title: Free jejunal graft repair after pharyngolaryngo-esophagectomy-risk factor analysis for postoperative dysphagia.
abstract: OBJECTIVE
  Reconstruction with free jejunal graft (FJG) has been widely accepted for patients undergone pharyngo-cervical esophageal resection. Those patients often suffer variety of complications regarding postoperative peros function. We investigated risk factors especially focused on the development of dysphagia after FJG reconstruction.
  
  
  METHODS
  A retrospective analysis was conducted using clinical chart review of 30 consecutive patients who underwent reconstruction with a FJG after pharyngo-laryngoesophagectomy from 1995 to 2010. Mortality, morbidity, and postoperative dysphagia were investigated. Dysphagia was defined when the patients required enteral nutrition until later than 1 month postoperatively without any other complications, including anastomotic leakage, anastomotic stricture, FJG ischemic necrosis, and hospital death. Data on potential clinical factors were extracted and the relation of these variables to postoperative dysphagia was examined by univariate and multivariate analysis.
  
  
  RESULTS
  There was one patient with hospital death over total 30 patients who deceased due to fatal postoperative bleeding from arterial anastomosis of FJG. Postoperative complications occurred in 14 patients (46.7%) those included respiratory complication in 5, anastomotic leakage 3, FJG ischemic necrosis 2, paralytic ileus 2, ischemic change of tracheostomy 2, anastomotic stricture 1 and dysphagia 9. Dysphagia was the most frequent in this series. Multivariate analysis demonstrated induction radiation (≥60 Gy) was independently significant factors for postoperative dysphagia.
  
  
  CONCLUSIONS
  FJG reconstruction may be safe and functionally satisfactory surgical option after pharyngo-laryngo-esophagectomy. Postoperative dysphagia may be induced prior radiation therapy.
authors: Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan.
authors: Ippei
authors: I
authors: Yamana
authors: Takeshi
authors: T
authors: Shiraishi
authors: Toyoo
authors: T
authors: Shiroshita
authors: Seiichiro
authors: S
authors: Hoshino
authors: Takayuki
authors: T
authors: Sueta
authors: Takashi
authors: T
authors: Nakagawa
authors: Yuichi
authors: Y
authors: Yamashita
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003680:Deglutition Disorders / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D004750:Enteral Nutrition; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome