Functional results following pharyngolaryngooesophagectomy with free jejunal graft reconstruction.

OBJECTIVE: A free jejunal graft is used for reconstruction following pharyngolaryngooesophagectomy, due to the relative ease of harvesting, low donor site morbidity and a lumen diameter compatible with that of the oesophagus. Our aim is to evaluate the postoperative outcome and functional results of the procedure.
METHODS: Retrospective analysis of 20 consecutive patients, with a mean age of 62.5 years (range 48--76), who underwent free jejunal reconstruction following pharyngolaryngooesophagectomy for laryngeal malignancy. Surgery was performed secondary to radiotherapy or as the main stem of treatment. The functional results were assessed at 6 months and 1 year and correlated with postoperative morbidity. Chi-square test was used for statistical significance and Kaplan--Meyer to estimate survival.
RESULTS: There were six transient leaks and six cases with anastomotic stricture. There was no morbidity associated with the donor site and the perioperative mortality (30 days) was zero. At 6 months, 13 (87%) out of the 15 patients alive had satisfactory speech and 11 (78%) had satisfactory swallowing. At 1 year, 11 patients were alive and maintained a satisfactory speech, while nine (81%) of them were eating well. The incidence of leaks, strictures, or the moment of radiotherapy has no influence on the functional outcome. The 1- and 3-year survival rates were 52.3 and 33.2%, respectively.
CONCLUSIONS: A free jejunal graft reconstruction is technically demanding, but provides a near-physiologic swallowing mechanism, avoiding the complications of a gastric pull-up procedure. Functional results are good and justify the procedure despite the relatively high co-morbidity.