Efficacy of tensed and straight free jejunum transfer for the reduction of postoperative dysphagia

Satsuki Tachibana, Shimpei Miyamoto, Takahiro Goto, Katsuhiro Ishida, Takuya Iida, Mutsumi Okazaki, Sei Yoshida, Shogo Nomura, Ryuichi Hayashi, Minoru Sakuraba

Research output: Contribution to journalArticle

Abstract

Background: Free jejunal transfer (FJT) is a standard method of reconstruction after total pharyngo-laryngo-cervical esophagectomy (TPLE) in patients with advanced head and neck cancer. However, it is related to various degrees of postoperative swallowing dysfunction. This study aimed to assess whether the tensed and straight FJT method results in a reduced rate of postoperative dysphagia compared with historical controls. Methods: Patients who were undergoing FJT after TPLE for squamous cell carcinoma of the hypopharynx or cervical esophagus were enrolled. The primary endpoint was the rate of not developing dysphagia within 6 months of the surgery, and we compared this value with that obtained from historical data of patients who underwent FJT. The secondary endpoint was the rate of developing surgical complications. Results: Although 128 patients were registered between August 2012 and July 2015, 7 were excluded based on the exclusion criteria. Of the remaining 121 patients, FJT with the craniocaudally tensed and straight method was performed in all patients. The rate of not developing dysphagia and its 95% confidence interval (CI) were 66.1% and 57.0-74.5%, respectively. The lower limit of the CI was higher than the prespecified threshold value of 50.0%. The rate of developing complications of total necrosis of the jejunum was 3.3%, cervical infection was 9.9%, and major anastomotic leakage was 4.1%. Conclusions: Our findings revealed that the proportion of postoperative dysphagia decreased in patients who underwent tensed and straight FJT. This method may become the standard surgical method in reconstruction of defects after TPLE.

Original languageEnglish
Article numbere1599
JournalPlastic and Reconstructive Surgery - Global Open
Volume5
Issue number12
DOIs
Publication statusPublished - Jan 1 2017

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Jejunum
Deglutition Disorders
Esophagectomy
Confidence Intervals
Hypopharynx
Anastomotic Leak
Deglutition
Head and Neck Neoplasms
Esophagus
Squamous Cell Carcinoma
Necrosis
Infection

All Science Journal Classification (ASJC) codes

  • Surgery

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Efficacy of tensed and straight free jejunum transfer for the reduction of postoperative dysphagia. / Tachibana, Satsuki; Miyamoto, Shimpei; Goto, Takahiro; Ishida, Katsuhiro; Iida, Takuya; Okazaki, Mutsumi; Yoshida, Sei; Nomura, Shogo; Hayashi, Ryuichi; Sakuraba, Minoru.

In: Plastic and Reconstructive Surgery - Global Open, Vol. 5, No. 12, e1599, 01.01.2017.

Research output: Contribution to journalArticle

Tachibana, S, Miyamoto, S, Goto, T, Ishida, K, Iida, T, Okazaki, M, Yoshida, S, Nomura, S, Hayashi, R & Sakuraba, M 2017, 'Efficacy of tensed and straight free jejunum transfer for the reduction of postoperative dysphagia', Plastic and Reconstructive Surgery - Global Open, vol. 5, no. 12, e1599. https://doi.org/10.1097/GOX.0000000000001599
Tachibana, Satsuki ; Miyamoto, Shimpei ; Goto, Takahiro ; Ishida, Katsuhiro ; Iida, Takuya ; Okazaki, Mutsumi ; Yoshida, Sei ; Nomura, Shogo ; Hayashi, Ryuichi ; Sakuraba, Minoru. / Efficacy of tensed and straight free jejunum transfer for the reduction of postoperative dysphagia. In: Plastic and Reconstructive Surgery - Global Open. 2017 ; Vol. 5, No. 12.
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AU - Tachibana, Satsuki

AU - Miyamoto, Shimpei

AU - Goto, Takahiro

AU - Ishida, Katsuhiro

AU - Iida, Takuya

AU - Okazaki, Mutsumi

AU - Yoshida, Sei

AU - Nomura, Shogo

AU - Hayashi, Ryuichi

AU - Sakuraba, Minoru

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N2 - Background: Free jejunal transfer (FJT) is a standard method of reconstruction after total pharyngo-laryngo-cervical esophagectomy (TPLE) in patients with advanced head and neck cancer. However, it is related to various degrees of postoperative swallowing dysfunction. This study aimed to assess whether the tensed and straight FJT method results in a reduced rate of postoperative dysphagia compared with historical controls. Methods: Patients who were undergoing FJT after TPLE for squamous cell carcinoma of the hypopharynx or cervical esophagus were enrolled. The primary endpoint was the rate of not developing dysphagia within 6 months of the surgery, and we compared this value with that obtained from historical data of patients who underwent FJT. The secondary endpoint was the rate of developing surgical complications. Results: Although 128 patients were registered between August 2012 and July 2015, 7 were excluded based on the exclusion criteria. Of the remaining 121 patients, FJT with the craniocaudally tensed and straight method was performed in all patients. The rate of not developing dysphagia and its 95% confidence interval (CI) were 66.1% and 57.0-74.5%, respectively. The lower limit of the CI was higher than the prespecified threshold value of 50.0%. The rate of developing complications of total necrosis of the jejunum was 3.3%, cervical infection was 9.9%, and major anastomotic leakage was 4.1%. Conclusions: Our findings revealed that the proportion of postoperative dysphagia decreased in patients who underwent tensed and straight FJT. This method may become the standard surgical method in reconstruction of defects after TPLE.

AB - Background: Free jejunal transfer (FJT) is a standard method of reconstruction after total pharyngo-laryngo-cervical esophagectomy (TPLE) in patients with advanced head and neck cancer. However, it is related to various degrees of postoperative swallowing dysfunction. This study aimed to assess whether the tensed and straight FJT method results in a reduced rate of postoperative dysphagia compared with historical controls. Methods: Patients who were undergoing FJT after TPLE for squamous cell carcinoma of the hypopharynx or cervical esophagus were enrolled. The primary endpoint was the rate of not developing dysphagia within 6 months of the surgery, and we compared this value with that obtained from historical data of patients who underwent FJT. The secondary endpoint was the rate of developing surgical complications. Results: Although 128 patients were registered between August 2012 and July 2015, 7 were excluded based on the exclusion criteria. Of the remaining 121 patients, FJT with the craniocaudally tensed and straight method was performed in all patients. The rate of not developing dysphagia and its 95% confidence interval (CI) were 66.1% and 57.0-74.5%, respectively. The lower limit of the CI was higher than the prespecified threshold value of 50.0%. The rate of developing complications of total necrosis of the jejunum was 3.3%, cervical infection was 9.9%, and major anastomotic leakage was 4.1%. Conclusions: Our findings revealed that the proportion of postoperative dysphagia decreased in patients who underwent tensed and straight FJT. This method may become the standard surgical method in reconstruction of defects after TPLE.

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