Background Factors Associated with Postoperative Complications in Patients with Advanced Hypopharyngeal Cancers Undergoing Total Pharyngolaryngoesophagectomy Followed by Free Jejunal Flap Reconstruction

Shintaro Fujimura; Hideaki Suzuki; Jun-ichi Ohkubo; Ryusuke Hori

doi:10.1055/s-0044-1786800

International Journal of Practical Otolaryngology, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · International Journal of Practical Otolaryngology 2024; 07(01): e16-e20
DOI: 10.1055/s-0044-1786800

Original Article

Background Factors Associated with Postoperative Complications in Patients with Advanced Hypopharyngeal Cancers Undergoing Total Pharyngolaryngoesophagectomy Followed by Free Jejunal Flap Reconstruction

Shintaro Fujimura

¹Department of Otorhinolaryngology – Head and Neck Surgery, University of Occupational and Environmental Health, Japan

,

Hideaki Suzuki

¹Department of Otorhinolaryngology – Head and Neck Surgery, University of Occupational and Environmental Health, Japan

,

Jun-ichi Ohkubo

¹Department of Otorhinolaryngology – Head and Neck Surgery, University of Occupational and Environmental Health, Japan

,

Ryusuke Hori

¹Department of Otorhinolaryngology – Head and Neck Surgery, University of Occupational and Environmental Health, Japan

› Institutsangaben

Abstract

We retrospectively analyzed background factors associated with postoperative complications in patients with advanced hypopharyngeal cancers who underwent total pharyngolaryngectomy followed by free jejunal flap reconstruction. A total of 23 participants, including 21 men and 2 women aged 49 to 83 years (average 72.3 years) were enrolled in this study. Mild and moderate/severe complications occurred in five and seven cases, respectively. The most common complication was stricture of the esophagojejunal anastomosis (nine cases). Other complications included two tracheostomal stenosis, one each for pneumonia and chyle leakage. The free jejunal flap survived in all cases. The disease-free survival rate was 47.8% at 52 weeks after surgery. The platelet count was significantly lower (18.8 ± 1.9 × 10⁴/mL vs. 27.7 ± 1.8 × 10⁴/mL; p = 0.008) in patients with moderate/severe complications than in those without. The percentage of stage IV cases and intraoperative blood loss tended to be higher in patients with complications than in those without. Knowledge of these potential risk factors for the development of postoperative complications to satisfactorily manage the clinical course of patients with advanced hypopharyngeal cancers is necessary.

Keywords

hypopharyngeal cancer - total pharyngolaryngectomy - postoperative complication - stricture of the esophagojejunal anastomosis - background factor

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References
1 Eckel HE, Bradley PJ. Natural history of treated and untreated hypopharyngeal cancer. Adv Otorhinolaryngol 2019; 83: 27-34
2 Bradley PJ. Symptoms and signs, staging and co-morbidity of hypopharyngeal cancer. Adv Otorhinolaryngol 2019; 83: 15-26
3 Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48 (03) 452-458
4 Sugiyama N, Kimata Y, Sekido M. et al. A multi-institutional study of reconstruction for laryngopharyngoesophagectomy. Jpn J Head Neck Cancer 2006; 32: 486-493
5 Denewer A, Khater A, Hafez MT. et al. Pharyngoesophageal reconstruction after resection of hypopharyngeal carcinoma: a new algorithm after analysis of 142 cases. World J Surg Oncol 2014; 12: 182
6 Carlson GW, Schusterman MA, Guillamondegui OM. Total reconstruction of the hypopharynx and cervical esophagus: a 20-year experience. Ann Plast Surg 1992; 29 (05) 408-412
7 Minami K, Inoue H, Kuba K. et al. Clinical analysis of free jejunal-autograft for pharyngoesophageal reconstruction in patients with head and neck cancer. J Saitama Med Sch 2017; 44: 9-14
8 Pattani KM, Byrne P, Boahene K, Richmon J. What makes a good flap go bad? A critical analysis of the literature of intraoperative factors related to free flap failure. Laryngoscope 2010; 120 (04) 717-723
9 Lin Y, He JF, Zhang X, Wang HM. Intraoperative factors associated with free flap failure in the head and neck region: a four-year retrospective study of 216 patients and review of the literature. Int J Oral Maxillofac Implants 2019; 48 (04) 447-451
10 Ohkubo JI, Wakasugi T, Takeuchi S, Takahashi A, Nguyen TN, Suzuki H. Biophysical properties of the neck skin indicating potential complications of salvage surgery for laryngeal/hypopharyngeal cancer. Acta Otolaryngol 2022; 142 (7-8): 634-637
11 Li N, Fei X, Li C, Zhao T, Jin H, Chen H. A rat model of esophagogastric anastomotic stricture. Eur Surg Res 2022; 63 (04) 294-301
12 Marroni N, Casadevall M, Panés J, Piera C, Jou JM, Pique JM. Effects of chronic normovolemic anemia on gastric microcirculation and ethanol-induced gastric damage in rats. Dig Dis Sci 1994; 39 (04) 751-757
13 Marchiori C, Fede A, Bassano M, Nieri A. Normovolemic hemodilution in head and neck surgery. Arch Otorhinolaryngol 1989; 246 (05) 333-335
14 Gu YM, Yang YS, Shang QX, Wang WP, Yuan Y, Chen LQ. Risk factors for benign anastomotic stricture post-oesophagectomy: single-centre analysis of 702 oesophagectomies with squamous cell carcinoma. Transl Cancer Res 2019; 8 (03) 828-835
15 Nasu T, Koike S, Noda D. et al. A clinical analysis on the outcome of free jejunal-autograft for reconstruction in head and neck cancer patients. Postoperative complications and swallowing function. Jpn J Head Neck Cancer 2009; 35: 293-299
16 Mori K, Sakata K, Hirano M. et al. Investigation of outcome of free jejunal autograft for head and neck reconstruction. Factors influencing on the success rate and swallowing function. J Jpn Bronchoesophagol Soc 1997; 48: 227-233
17 Reece GP, Bengtson BP, Schusterman MA. Reconstruction of the pharynx and cervical esophagus using free jejunal transfer. Clin Plast Surg 1994; 21 (01) 125-136
18 Ueda Y, Takashima M, Hashimoto K. Methods for graft tissue monitoring after tissue transplantation using microsurgery; usefulness of pulse oximeter. J Jpn Coll Surg 1996; 21: 14-21
19 Yano A, Orihashi K, Yoshida Y, Kuriyama M. Near-infrared spectroscopy for monitoring free jejunal flap. J Plast Reconstr Aesthet Surg 2021; 74 (01) 108-115