title: Microvascular Reconstruction of Free Jejunal Graft in Larynx-preserving Esophagectomy for Cervical Esophageal Carcinoma.
abstract: BACKGROUND
  Losing the ability to speak severely affects the quality of life, and patients who have undergone laryngectomy tend to become depressed, which may lead to social withdrawal. Recently, with advancements in chemoradiotherapy and with alternative perspectives on postoperative quality of life, larynx preservation has been pursued; however, the selection of candidates and the optimal reconstructive procedure remain controversial. In this study, we retrospectively reviewed our experience with free jejunal graft for larynx-preserving cervical esophagectomy (LPCE), focusing on microvascular reconstruction.
  
  
  METHODS
  Seven patients underwent LPCE for cervical esophageal carcinoma, and defects were reconstructed by free jejunal transfer subsequently. We collected preoperative and postoperative data of the patients and assessed the importance of the procedure.
  
  
  RESULTS
  We mostly used the transverse cervical artery as the recipient, and a longer operative time was required, particularly for the regrowth cases. The operative field for microvascular anastomosis was more limited and deeper than those in the laryngectomy cases. Two graft necrosis cases were confirmed at postoperative day 9 or 15, and vessels contralateral from the graft were chosen as recipients in both patients.
  
  
  CONCLUSIONS
  Microvascular reconstruction for free jejunal graft in LPCE differed in several ways from the procedure combined with laryngectomy. Compression from the tracheal cartilage to the pedicle was suspected as the reason of the necrosis clinically and pathologically. Therefore, we should select recipient vessels from the ipsilateral side of the graft, and careful and extended monitoring of the flap should be considered to make this procedure successful.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, AOI Universal Hospital, Kanagawa, Japan; Department of Plastic and Reconstructive Surgery, Juntendo University Sizuoka Hospital, Sizuoka, Japan; and Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Ayato
authors.initials: A
authors.lastname: Hayashi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, AOI Universal Hospital, Kanagawa, Japan; Department of Plastic and Reconstructive Surgery, Juntendo University Sizuoka Hospital, Sizuoka, Japan; and Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Natori
authors.affiliation: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, AOI Universal Hospital, Kanagawa, Japan; Department of Plastic and Reconstructive Surgery, Juntendo University Sizuoka Hospital, Sizuoka, Japan; and Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Komoto
authors.affiliation: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, AOI Universal Hospital, Kanagawa, Japan; Department of Plastic and Reconstructive Surgery, Juntendo University Sizuoka Hospital, Sizuoka, Japan; and Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsumura
authors.affiliation: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, AOI Universal Hospital, Kanagawa, Japan; Department of Plastic and Reconstructive Surgery, Juntendo University Sizuoka Hospital, Sizuoka, Japan; and Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Horiguchi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, AOI Universal Hospital, Kanagawa, Japan; Department of Plastic and Reconstructive Surgery, Juntendo University Sizuoka Hospital, Sizuoka, Japan; and Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Yoshizawa
authors.affiliation: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, AOI Universal Hospital, Kanagawa, Japan; Department of Plastic and Reconstructive Surgery, Juntendo University Sizuoka Hospital, Sizuoka, Japan; and Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Iwanuma
authors.affiliation: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, AOI Universal Hospital, Kanagawa, Japan; Department of Plastic and Reconstructive Surgery, Juntendo University Sizuoka Hospital, Sizuoka, Japan; and Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Masahioko
authors.initials: M
authors.lastname: Tsurumaru
authors.affiliation: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, AOI Universal Hospital, Kanagawa, Japan; Department of Plastic and Reconstructive Surgery, Juntendo University Sizuoka Hospital, Sizuoka, Japan; and Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kajiyama
authors.affiliation: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, AOI Universal Hospital, Kanagawa, Japan; Department of Plastic and Reconstructive Surgery, Juntendo University Sizuoka Hospital, Sizuoka, Japan; and Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mizuno