title: Usefulness of the Clavien-Dindo Classification in Understanding the Limitations and Indications of Larynx-preserving Esophageal Reconstruction.
abstract: BACKGROUND
  The Clavien-Dindo (CD) classification is used to evaluate the severity of surgical complications. However, its usefulness in esophageal reconstruction has not been reported. To address this, this case series study used the CD classification to evaluate the complications after cervical esophageal reconstruction with free jejunum transfer or supercharged pedicled intestinal transfer.
  
  
  METHODS
  All consecutive patients who underwent esophageal cancer surgery with larynx-preserving free jejunum or pedicled ileocolic transfer in June 2012-December 2015 were identified. The postoperative complications were classified using the CD classification.
  
  
  RESULTS
  In total, 22 patients (20 men and 2 women; mean age, 63.3 years) underwent esophageal cancer reconstruction with larynx-preserving free jejunum transfer (n = 9) and supercharged pedicled intestinal transfer (n = 13). Seven patients underwent prophylactic tracheotomy. Four patients underwent emergent tracheotomy 1 or 5 days after surgery. The most frequent complication was recurrent nerve paralysis (RNP) (n = 8). Of these 8 RNP cases, 6 and 2 were classified as CD I and III complications, respectively. Pneumonia was the next most common complication (n = 7). Of these 7 pneumonia cases, 5 and 2 were classified as CD II and III, respectively. There were 2 cases of intestinal anastomosis leakage (CD II and III). On average, patients were able to start oral alimentation 15.1 (9-35) days after surgery.
  
  
  CONCLUSIONS
  Our analysis with the CD classification suggested that vascularized free jejunum transfer or supercharge-drainage pedicled ileocolic transfer prevents postoperative intestinal anastomosis leakage and that prophylactic tracheotomy is especially indicated in cases with significant surgical damage in the cervical region.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery (H.U., J.N., H.K., M.T., R.O.) and Department of Surgery, Nippon Medical School Hospital, Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Umezawa
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery (H.U., J.N., H.K., M.T., R.O.) and Department of Surgery, Nippon Medical School Hospital, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Nakao
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery (H.U., J.N., H.K., M.T., R.O.) and Department of Surgery, Nippon Medical School Hospital, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsutani
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery (H.U., J.N., H.K., M.T., R.O.) and Department of Surgery, Nippon Medical School Hospital, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kuwahara
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery (H.U., J.N., H.K., M.T., R.O.) and Department of Surgery, Nippon Medical School Hospital, Tokyo, Japan.
authors.forename: Marie
authors.initials: M
authors.lastname: Taga
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery (H.U., J.N., H.K., M.T., R.O.) and Department of Surgery, Nippon Medical School Hospital, Tokyo, Japan.
authors.forename: Rei
authors.initials: R
authors.lastname: Ogawa