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.