title: Gastric pull-up reconstruction combined with free jejunal transfer (FJT) following total pharyngolaryngo-oesophagectomy (PLE).
abstract: BACKGROUND
  Reconstruction following total pharyngolaryngo-oesophagectomy (PLE) still challenges surgeons because of the extreme length of removed tissue. Gastric pull-up reconstruction, one of the most common reconstructive methods after PLE, has many complications such as anastomotic fistula and gastric necrosis caused by the high anastomotic tension. However, modifications of gastric pull-up reconstruction aiming to reducing the high anastomotic tension have been less reported compared with other aspects with this technique. Here we report a modified gastric pull-up reconstruction combined with free jejunal transfer (FTJ) to reduce the anastomosis tension, and thus to reduce the risk of complications after PLE.
  
  
  METHODS
  Patients underwent a standard surgical procedure including total pharyngolaryngo-oesophagectomy and bilateral internal jugular lymph nodal clearance. A free jejunal graft about 10 cm was harvested and placed in the appropriate position between mobilized stomach and oropharynx. The anastomosis between the free jejunal graft and the gastric tube was created through a stapler. Vascular anastomosis was made between the jejunal artery and the transverse cervical artery, and between the jejunal vein and the internal jugular vein. Hand suturing technique was used in the anastomosis between jejunum and pharynx.
  
  
  RESULTS
  None of the patients suffered from any complications such as anastomotic fistula. Both patients resumed early postoperative oral intake. So far, they remain free of tumor recurrence and are in good health for 46 and 18 months, respectively.
  
  
  CONCLUSIONS
  Considering the tumor status and the patient condition, the gastric pull-up reconstruction combined with FJT after PLE could be a reliable choice.
authors: Department of Head and Neck Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China.
authors: Song
authors: S
authors: Ni
authors: Department of Head and Neck Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China.
authors: Yiming
authors: Y
authors: Zhu
authors: Department of Head and Neck Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China.
authors: Dezhi
authors: D
authors: Li
authors: Department of Head and Neck Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China.
authors: Zhengjiang
authors: Z
authors: Li
authors: Department of Head and Neck Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China.
authors: Yuehuang
authors: Y
authors: Wu
authors: Department of Head and Neck Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China.
authors: Zhengang
authors: Z
authors: Xu
authors: Department of Head and Neck Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China. Electronic address: shaoyanliu.bj@263.net.
authors: Shaoyan
authors: S
authors: Liu
mesh_terms: D000328:Adult; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D004944:Esophagoplasty / Q000379:methods; D005260:Female; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010610:Pharyngeal Neoplasms / Q000601:surgery; D010611:Pharyngectomy / Q000379:methods*; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*
keywords: Anastomosis; Free jejunal transfer; Gastric pull-up surgery; Total pharyngolaryngo-oesophagectomy