Reconstruction of the pharynx and cervical esophagus presents a tremendous challenges to surgeons.
Over the past 2 years(1990, Dec.~1993, Jun.), the free jejunal graft has been performed in 17 cases in Korea Cancer Center Hospital.
The indications of this procedures were almost malignant neoplasms involving neck and upper aerodigestive tract; Hypopharyngeal cancer(12 cases, including 2 recurrent cases0, laryngeal cancer(2 cases), thyroid cancer(2 cases, including 1
recurrent
case), cervical esophageal cancer(1 case). There were fifteen and two women, and the mean age was 59.6 years.
The anastomosis site of jejunal artery were common carotid artery(16 cases) or external carotid artery( 1 case) and that of jejunal vein were internal jugular(15 cases) or facial( 1 case) and superior thyroid vein(1 case). The length of jejunal
graft
was from 9cm to 17cm(mean 13mc) and the mean ischemic time was 68 minutes.
There was one hospital mortality which was irrelevant to procedures(variceal bleeding ) and one graft failure(1/16). Other postoperative complications were neck bleeding or hematoma( 3 cases), abdominal wound infection or disruption( 5 cases),
anastomosis site leakage( 1 case0, pneumonia( 2 cases0, graft vein thrombosis( 1case), and food aspiration (1 case).
The function of conduit was exellent and ingestion of food was possible in nearly all cases. Postoperative adjuvant radiation therapy was also applicable without problem in 7 cases.
During follow-up periods, the anastomosis site stenosis developed in four patients, and the tracheal stoma was narrowed in one case but easily overcomed with dilation.
In conclusion, we think that the free jejunal graft is one of the exellent reconstruction methods of upper digestive tract, especially after radical resection of malignant neoplasm in neck with a high success rate and low mortality and morbidity
rate.
(Korean J Thoracic Cardiovas Surg 1994; 27:140-7)
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