[Reconstruction of the digestive tract using a free small intestine interpositional graft following total larynx-pharynx extirpation. Follow-up results].

OBJECTIVE

To evaluate the results of pharyngo-oesophageal reconstruction after pharyngolaryngectomy using a free jejunal interposition graft.

DESIGN

Retrospective study.

SETTING

University Hospital Dijkzigt, Rotterdam.

PATIENTS AND METHODS

Between 1982 and 1992, 59 selected patients (median age 63 years) undergoing laryngopharyngectomy for cancer had the continuity of the upper gastrointestinal tract restored by use of a free jejunal autograft. Twenty-three (36%) had had no previous treatment and received post-operative radiotherapy. Eight patients had laryngeal tumour recurrence after irradiation and in 28 (48%) patients pre-operative radiotherapy had been administered.

RESULTS

Follow-up ranged from 1-127 months (mean 37 months). Graft necrosis secondary to vascular problems initially occurred in 5 patients. In four cases the jejunum was successfully replaced by another segment and in one patient a gastric transposition was performed. Fistulas occurred in eight patients of whom four required surgery. The mortality rate was 8.5%. After discharge 6 patients were reoperated on for dysphagia due to stricture formation. In four cases the distal or proximal anastomosis was revised and in the other two patients the graft was replaced, by another segment and by a colonic autograft, respectively. One year after operation 85% of the patients reported an adequate swallowing function and a normal oral intake. The overall 5-year survival rate of this selected group of patients was 42%, for those without primary lymph node involvement 66%. All patients with primary locoregional metastasis died within a period of 34 months after operation.

CONCLUSION

Reconstruction of the upper alimentary tract after a laryngopharyngectomy with a free jejunal autograft appears to be a relatively safe procedure with an acceptable mortality and morbidity and, in patients without local lymph node involvement, good long-term results.