title: Modified gastric pull-up reconstructions following pharyngolaryngectomy with total esophagectomy.
abstract: Reconstruction following pharyngolaryngectomy with total esophagectomy is a challenging surgery to perform. Between April 2008 and August 2012, three types of modified gastric pull-up reconstruction procedures, including a gastric tube creation combined with a free jejunal transfer (n = 7), elongated gastric tube creation with vascular anastomoses (n = 2) and pedunculated gastric tube creation with Roux-en-Y anastomosis (n = 5), were performed after pharyngolaryngectomy with total esophagectomy. To clarify feasibility of these reconstructive methods, we retrospectively analyzed the short-term outcomes. There were no graft failures. Salivary fistulae were observed in two cases after high pharyngoenteral anastomoses due to oropharyngeal extension of hypopharyngeal cancers. Overall morbidity rate was 21.4%, and no deaths occurred. Although the operation time was shortest for pedunculated gastric tube reconstructions, morbidity rates were similar among all methods. All three types of modified gastric pull-up reconstruction procedures can be performed safely. We can choose one of these methods according to the tumor status and the patient condition, understanding advantages and disadvantages of each procedure.
authors.affiliation: Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Watanabe
authors.forename: Y
authors.initials: Y
authors.lastname: Baba
authors.forename: N
authors.initials: N
authors.lastname: Yoshida
authors.forename: T
authors.initials: T
authors.lastname: Ishimoto
authors.forename: H
authors.initials: H
authors.lastname: Sakaguchi
authors.forename: M
authors.initials: M
authors.lastname: Kawasuji
authors.forename: H
authors.initials: H
authors.lastname: Baba
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D002277:Carcinoma / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects; D004944:Esophagoplasty / Q000009:adverse effects / Q000379:methods*; D006085:Graft Survival; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000150:complications / Q000601:surgery*; D007583:Jejunum / Q000637:transplantation*; D007825:Laryngectomy / Q000009:adverse effects; D058753:Laryngoplasty / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000601:surgery*; D061646:Operative Time; D010611:Pharyngectomy / Q000009:adverse effects; D010614:Pharynx / Q000601:surgery*; D012189:Retrospective Studies; D012467:Salivary Gland Fistula / Q000209:etiology*; D013270:Stomach / Q000601:surgery*; D013997:Time Factors
keywords: graft necrosis prevention; pharyngolaryngectomy with total esophagectomy; reconstruction