Chang Tzu-Yen, Hsiao Jenn-Ren, Lee Wei-Ting, Ou Chun-Yen, Yen Yi-Ting, Tseng Yau-Lin, Pan Shin-Chen, Shieh Shyh-Jou, Lee Yao-Chou
Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, Dou-Liou Branch, College of Medicine, Yunlin, Taiwan.
Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Microsurgery. 2019 Jan;39(1):6-13. doi: 10.1002/micr.30304. Epub 2018 Feb 5.
Reconstruction for total laryngopharyngoesophagectomy is accomplished mainly by gastrointestinal transposition but can be complicated by anastomotic tension or associated neck-skin defect. Here, we present the results of total esophageal reconstruction by gastrointestinal transposition alone or with additional free tissue transfer and propose an algorithm accordingly.
We reviewed patients who had oncologic total laryngopharyngoesophagectomy between January 2012 and January 2016. Twenty-four men and one woman were included with a mean age of 54 (range, 41-72) years. Patients were grouped by reconstruction into the gastric pull-up (GP, n = 15), colon interposition (CI, n = 2), GP combined with free jejunal flap (GPFJ, n = 6), or GP combined with anterolateral thigh flap (GPALT, n = 2) group to compare clinical outcomes.
The mean operation time was 1037.3 minutes and was significantly longer in the GPALT group than in the GP group (1235.0 ± 50.0 minutes vs. 929.7 ± 137.7 minutes, p =.009). All flaps survived. After a mean follow-up of 18 months, the overall leakage, stricture, and successful swallowing rates were 44%, 4%, and 76%, respectively. There was no significant difference in the leakage (53.3%, 50.0%, 16.7%, and 50.0%, p =.581), stricture (6.7%, 0%, 0%, and 0%, p = 1.000), or successful swallowing (73.3%, 50.0%, 83.3%, and 100%, p =.783) rates between GP, CI, GPFJ, and GPALT groups, respectively.
The proposed algorithm that ranks gastric pull-up as a priority and uses additional free tissue transfer to overcome the anastomotic tension or associated neck-skin defect is feasible.
全喉咽食管切除术的重建主要通过胃肠道转位完成，但可能会出现吻合口张力或相关颈部皮肤缺损等并发症。在此，我们展示了单独通过胃肠道转位或联合游离组织移植进行全食管重建的结果，并据此提出一种算法。
我们回顾了2012年1月至2016年1月期间接受肿瘤性全喉咽食管切除术的患者。纳入24名男性和1名女性，平均年龄54岁（范围41 - 72岁）。患者按重建方式分为胃上提组（GP，n = 15）、结肠间置组（CI，n = 2）、胃上提联合游离空肠瓣组（GPFJ，n = 6）或胃上提联合股前外侧皮瓣组（GPALT，n = 2），以比较临床结果。
平均手术时间为1037.3分钟，GPALT组明显长于GP组（1235.0 ± 50.0分钟对929.7 ± 137.7分钟，p = 0.009）。所有皮瓣均存活。平均随访18个月后，总体漏出、狭窄和成功吞咽率分别为44%、4%和76%。GP、CI、GPFJ和GPALT组之间的漏出率（53.3%、50.0%、16.7%和50.0%，p = 0.581）、狭窄率（6.7%、0%、0%和0%，p = 1.000）或成功吞咽率（73.3%、50.0%、83.3%和100%，p = 0.783）均无显著差异。
所提出的将胃上提作为优先选择并使用额外游离组织移植来克服吻合口张力或相关颈部皮肤缺损的算法是可行的。
