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.