Efficacy of Tensed and Straight Free Jejunum Transfer for the Reduction of Postoperative Dysphagia
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 whe...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2017-12-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001599 |
| _version_ | 1819072762281459712 |
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| author | Satsuki Tachibana, MD Shimpei Miyamoto, MD, PhD Takahiro Goto, MD, PhD Katsuhiro Ishida, MD Takuya Iida, MD, PhD Mutsumi Okazaki, MD, PhD Sei Yoshida, MD Shogo Nomura, ME Ryuichi Hayashi, MD Minoru Sakuraba, MD, PhD |
| author_facet | Satsuki Tachibana, MD Shimpei Miyamoto, MD, PhD Takahiro Goto, MD, PhD Katsuhiro Ishida, MD Takuya Iida, MD, PhD Mutsumi Okazaki, MD, PhD Sei Yoshida, MD Shogo Nomura, ME Ryuichi Hayashi, MD Minoru Sakuraba, MD, PhD |
| author_sort | Satsuki Tachibana, MD |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-21T17:42:53Z |
| format | Article |
| id | doaj.art-e64b060c74ad4d4c949efe60a77399e2 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-21T17:42:53Z |
| publishDate | 2017-12-01 |
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| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-e64b060c74ad4d4c949efe60a77399e22022-12-21T18:55:35ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742017-12-01512e159910.1097/GOX.0000000000001599201712000-00019Efficacy of Tensed and Straight Free Jejunum Transfer for the Reduction of Postoperative DysphagiaSatsuki Tachibana, MD0Shimpei Miyamoto, MD, PhD1Takahiro Goto, MD, PhD2Katsuhiro Ishida, MD3Takuya Iida, MD, PhD4Mutsumi Okazaki, MD, PhD5Sei Yoshida, MD6Shogo Nomura, ME7Ryuichi Hayashi, MD8Minoru Sakuraba, MD, PhD9From the *Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; †Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; ‡Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; §Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; ¶Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; ‖Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; **Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; ††Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; ‡‡Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; §§Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and ¶¶Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan.From the *Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; †Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; ‡Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; §Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; ¶Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; ‖Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; **Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; ††Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; ‡‡Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; §§Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and ¶¶Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan.From the *Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; †Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; ‡Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; §Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; ¶Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; ‖Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; **Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; ††Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; ‡‡Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; §§Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and ¶¶Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan.From the *Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; †Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; ‡Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; §Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; ¶Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; ‖Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; **Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; ††Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; ‡‡Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; §§Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and ¶¶Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan.From the *Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; †Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; ‡Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; §Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; ¶Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; ‖Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; **Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; ††Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; ‡‡Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; §§Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and ¶¶Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan.From the *Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; †Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; ‡Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; §Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; ¶Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; ‖Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; **Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; ††Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; ‡‡Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; §§Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and ¶¶Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan.From the *Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; †Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; ‡Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; §Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; ¶Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; ‖Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; **Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; ††Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; ‡‡Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; §§Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and ¶¶Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan.From the *Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; †Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; ‡Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; §Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; ¶Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; ‖Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; **Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; ††Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; ‡‡Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; §§Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and ¶¶Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan.From the *Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; †Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; ‡Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; §Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; ¶Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; ‖Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; **Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; ††Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; ‡‡Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; §§Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and ¶¶Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan.From the *Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; †Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; ‡Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; §Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; ¶Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; ‖Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; **Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; ††Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; ‡‡Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; §§Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and ¶¶Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan.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.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001599 |
| spellingShingle | Satsuki Tachibana, MD Shimpei Miyamoto, MD, PhD Takahiro Goto, MD, PhD Katsuhiro Ishida, MD Takuya Iida, MD, PhD Mutsumi Okazaki, MD, PhD Sei Yoshida, MD Shogo Nomura, ME Ryuichi Hayashi, MD Minoru Sakuraba, MD, PhD Efficacy of Tensed and Straight Free Jejunum Transfer for the Reduction of Postoperative Dysphagia Plastic and Reconstructive Surgery, Global Open |
| title | Efficacy of Tensed and Straight Free Jejunum Transfer for the Reduction of Postoperative Dysphagia |
| title_full | Efficacy of Tensed and Straight Free Jejunum Transfer for the Reduction of Postoperative Dysphagia |
| title_fullStr | Efficacy of Tensed and Straight Free Jejunum Transfer for the Reduction of Postoperative Dysphagia |
| title_full_unstemmed | Efficacy of Tensed and Straight Free Jejunum Transfer for the Reduction of Postoperative Dysphagia |
| title_short | Efficacy of Tensed and Straight Free Jejunum Transfer for the Reduction of Postoperative Dysphagia |
| title_sort | efficacy of tensed and straight free jejunum transfer for the reduction of postoperative dysphagia |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001599 |
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