METHODS
Three male patients with advanced SCCHP invading cervical esophageal without partial response on two cycle of induction chemotherapy[Cisplatin (DDP) + 5-fluorouracil (5-FU)] were collected in <Blinded for review>. The preoperatively clinical characteristics and stage (International Union Against Cancer, 2010) of the three patients were listed in Table 1. All the patients were diagnosed with SCCHP by histopathological examination in our hospital. Then we conducted radical tumor resection followed by chemoradiotherapy for these patients. The present study was approved by the Ethics Committee of <Blinded for review>.
Bilateral neck selective dissection, partial cervical esophagectomy and tumor resection with an 1 cm safe margin was performed in the three patients (Figure 1a).Partial hypopharyngectomy was conducted in 2/3 patients, total hypopharyngectomy in 1/3 patients; partial laryngectomy in 1/3 patients. Three patients’ larynx was partially or completely preserved. Meanwhile, the recipient vessels and superior and recurrent laryngeal nerves were identified and preserved.
A free jejunal graft transfer(FJGT) was harvested and partially incised in longitudinal axis along the antimesenteric border to gain a FJGTs with partial patch and tube (Figure 1 b and c). The FJGTs were transferred to the defect site and sutured to the residual edge of pharynx, esophagus and larynx(Figure 1 d). Then the vessels anastomosis was conducted.
To monitor survival status of the FJGTs, a “mini watch jejunum” was made and kept outside of the neck incision (Figure 1d). After wound recovery, all patients received adjuvant radiotherapy and 2/3 of them also received chemotherapy(two-cycles of DDP+ 5-FU).
The operative complications, the function of pharynx, esophagus and larynx reconstructed were evaluated. Also the survival state of patients were collected.
RESULTS
Postoperative information was listed in Table 2.
The three FJGTs were all survival after surgery(Figure 2). One patient had a subcutaneous infection. With treatments (e.g.drainage, dressing changes, systemic antibiotic treatment and nutritional support), the patient recovered within four weeks. None of the three patients had donor site complications.
The time of oral feeding after operation ranged from 21 to 40 days, and hospital day from 14 to 35 days. All the patients were tracheostomy dependent after operation, and the duration time from surgery to decannulation ranged from 4 months to 5 months.
Two patients could communicate with others freely after treatment. Although one patient’s speech function was affected, he still could communicate with others by speech. The three patients had normal swallowing function.
The follow-up time ranged from 52 to 74 months. Two patients survived without tumor relapse and metastasis when data were collected. One patient suffered from lymph node metastasis of the posterior pharyngeal space 36 months after treatment (Table 2).A second surgery and followed chemoradiotherapy was conducted for the patient. Interestingly, the jejunal graft transfer still functioned.