DISCUSSION
Induction chemotherapy followed by
radiotherapy or synchronous chemoradiation have been the main treatment
for SCCHP patients [2]. In our cases, the tumors were not controlled
by induction chemotherapy. For those patients, radical surgery usually
include total laryngopharyngectomy and cervical esophageal
resection[3], which would lead to huge and complex defect in the
boundary
between respiration and digestive tract. As a great challenge, even some
cases without larynx invasion, the total laryngectomy was performed to
facility the defect reconstruction [4].
Jejunum is a reconstructive choice for the hypopharynx and cervical
esophagus defect. As a tube, jejunum used to recover the continuity of
hypopharynx and cervical esophagus often need to remove larynx.
Nakatsuka and Miyamoto et al.[5] had used jejunal patch to
reconstruct the defect of hypopharynx with laryngeal preservation.
However, whether the jejunal tube or patch alone, it is still great
challenge for surgeons to repair the complex defect of hypopharynx with
larynx preservation, especially when the cervical esophagus was invaded.
To preserve the larynx, we incised jejunum partially along the
longitudinal axis to gain a partial patch and tube FJGTs other than
previous tube or patch shape alone, so that the FJGTs could be suitable
for the complex defect owing to the preservation of larynx.
In our cases, all the FJGTs survived, even after radiation, which
indicated that partially longitudinal incision of free jejunum did not
increase the risk of necrosis of FJGTs, even the partial patch and tube
FJGTs can be tolerance to radiotherapy. Importantly, all of them
obtained the preservation of larynx presented with tracheostomy
independency and speech function. Only one patients’ speech function
was weakened. However, he still could communicate with others by speech.
At least, he could avoid tracheostomy independency. One patients
suffered from posterior pharyngeal space lymph node metastasis after the
first operation. The transplant jejunum still survived after lymph node
dissection followed by the second radical chemoradiotherapy.