Plastic and Reconstructive Surgery, Global Open (Dec 2017)
Efficacy of Tensed and Straight Free Jejunum Transfer for the Reduction of Postoperative Dysphagia
- 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
Affiliations
- Satsuki Tachibana, MD
- 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.
- Shimpei Miyamoto, MD, PhD
- 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.
- Takahiro Goto, MD, PhD
- 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.
- Katsuhiro Ishida, MD
- 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.
- Takuya Iida, MD, PhD
- 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.
- Mutsumi Okazaki, MD, PhD
- 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.
- Sei Yoshida, MD
- 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.
- Shogo Nomura, ME
- 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.
- Ryuichi Hayashi, MD
- 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.
- Minoru Sakuraba, MD, PhD
- 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.
- DOI
- https://doi.org/10.1097/GOX.0000000000001599
- Journal volume & issue
-
Vol. 5,
no. 12
p. e1599
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.