A Nationwide Survey on Digestive Reconstruction Following Pharyngolaryngectomy With Total Esophagectomy: A Multicenter Retrospective Study in Japan.

Autor: Okamura A; Department of Esophageal Surgery Gastroenterology Center Cancer Institute Hospital of Japanese Foundation for Cancer Research Tokyo Japan., Watanabe M; Department of Esophageal Surgery Gastroenterology Center Cancer Institute Hospital of Japanese Foundation for Cancer Research Tokyo Japan., Mukoyama N; Department of Otolaryngology Graduate School of Medicine Nagoya University Nagoya Japan., Ota Y; Department of Gastrointestinal and Pediatric Surgery Tokyo Medical University Tokyo Japan., Shiraishi O; Department of Surgery Faculty of Medicine Kindai University Osaka Japan., Shimbashi W; Department of Head and Neck Surgery Cancer Institute Hospital of Japanese Foundation for Cancer Research Tokyo Japan., Baba Y; Department of Gastroenterological Surgery Graduate School of Medical Sciences Kumamoto University Kumamoto Japan., Matsui H; Department of Head and Neck Surgery Hyogo Cancer Center Hyogo Japan., Shinomiya H; Department of Otolaryngology-Head and Neck Surgery Kobe University Graduate School of Medicine Hyogo Japan., Sugimura K; Department of Digestive Surgery Osaka International Cancer Institute Osaka Japan., Morita M; Department of Gastroenterological Surgery National Hospital Organization Kyushu Cancer Center Fukuoka Japan., Sakai M; Department of General Surgical Science Gunma University Graduate School of Medicine Gunma Japan., Sato H; Department of Gastroenterological Surgery Saitama Medical University International Medical Center Saitama Japan., Shibata T; Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan., Nasu M; Department of Esophageal and Gastroenterological Surgery Juntendo University School of Medicine Tokyo Japan., Matsumoto S; Department of Otolaryngology-Head and Neck Surgery Kochi University Kochi Japan., Toh Y; Department of Gastroenterological Surgery National Hospital Organization Kyushu Cancer Center Fukuoka Japan.; The Japan Broncho-Esophagological Society Japan., Shiotani A; The Japan Broncho-Esophagological Society Japan.; Department of Otolaryngology-Head and Neck Surgery National Defense Medical College Saitama Japan.
Jazyk: angličtina
Zdroj: Annals of gastroenterological surgery [Ann Gastroenterol Surg] 2021 Sep 22; Vol. 6 (1), pp. 54-62. Date of Electronic Publication: 2021 Sep 22 (Print Publication: 2022).
DOI: 10.1002/ags3.12509
Abstrakt: Aim: Digestive reconstruction after pharyngolaryngectomy with total esophagectomy (PLTE) remains challenging, with the optimal method remaining unclear. The current study aimed to clarify the short-term outcomes after PLTE and determine the optimal digestive reconstruction method.
Methods: Based on a nationwide survey of 151 patients who underwent PLTE, outcomes of digestive reconstruction methods are described.
Results: Among digestive reconstruction methods, a simple gastric tube was most frequently used (37.1%), followed by gastric tube combined with free graft transfer (FGT) (35.1%), gastric tube with microvascular anastomosis (22.5%), and other procedures (5.3%). Intraoperative evaluation of microcirculation (IOEM) was utilized in 29 patients (19.2%). Among the included patients, 66.9% developed any-grade complications, 41.0% developed severe complications, and 23.8% developed digestive reconstruction-related complications (DRRCs; leakage or necrosis). Reoperation within 30 days for any complications and DRRCs was required in 13.9% and 8.6% of the patients, respectively. Mortality within 90 days was observed in 4.6%. Among the three major methods, gastric tube combined with FGT promoted the least DRRCs in the gastric tube ( P =  .005), although the overall incidence of DRRCs was comparable. The use of IOEM was significantly associated with a reduction of severe DRRCs ( P =  .005).
Conclusions: Pharyngolaryngectomy with total esophagectomy is a high-risk surgery significantly associated with the occurrence of postoperative morbidity and mortality. Nonetheless, the addition of FGT can help prevent gastric tip complications, while IOEM can be an effective method for improving outcomes.
Competing Interests: FundingAuthor Y.B. has an endowed chair funded by Ono Pharmaceutical Co. Ltd.Conflict of InterestThe authors have no conflicts of interest related to this research and have received no grant support for this work.Ethical StatementsThis retrospective study was performed in accordance with the ethical standards of each institution's committee on human experimentation and with the Helsinki Declaration of 1964 and its later versions. Patients were given an opportunity to optout of this study through public announcements published by each institution. The study protocol was approved by the JBES (approval number 2020‐01) and the Institutional Review Board of the Japanese Foundation for Cancer Research (approval number 2020‐1147). All institutions applied for and obtained study approval from their respective institutional review boards.The authors have no conflicts of interest related to this research and have received no grant support for this work.
(© 2021 The Authors. Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterology.)
Databáze: MEDLINE
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