TY - JOUR
T1 - A Nationwide Survey on Digestive Reconstruction Following Pharyngolaryngectomy With Total Esophagectomy
T2 - A Multicenter Retrospective Study in Japan
AU - the Japan Broncho-Esophagological Society, Pharyngolaryngectomy with Total Esophagectomy (JBES-PLTE) Study Group
AU - Okamura, Akihiko
AU - Watanabe, Masayuki
AU - Mukoyama, Nobuaki
AU - Ota, Yoshihiro
AU - Shiraishi, Osamu
AU - Shimbashi, Wataru
AU - Baba, Yoshifumi
AU - Matsui, Hidetoshi
AU - Shinomiya, Hirotaka
AU - Sugimura, Keijiro
AU - Morita, Masaru
AU - Sakai, Makoto
AU - Sato, Hiroshi
AU - Shibata, Tomotaka
AU - Nasu, Motomi
AU - Matsumoto, Shuichi
AU - Toh, Yasushi
AU - Shiotani, Akihiro
AU - Kawata, Ryo
AU - Kishimoto, Yo
AU - Sakuma, Jun
AU - Okoshi, Akira
AU - Kato, Hisayuki
AU - Shinohara, Shogo
AU - Suzuki, Mikio
AU - Takeno, Shinsuke
AU - Chida, Kuniaki
AU - Higashikawa, Masahiko
AU - Miyamoto, Shunsuke
AU - Ishinaga, Hajime
AU - Uno, Kosuke
AU - Okamura, Jun
AU - Sakamoto, Koji
AU - Fukuda, Yujiro
AU - Mitani, Sohei
N1 - Publisher Copyright:
© 2021 The Authors. Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterology.
PY - 2022/1
Y1 - 2022/1
N2 - 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.
AB - 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.
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U2 - 10.1002/ags3.12509
DO - 10.1002/ags3.12509
M3 - Article
AN - SCOPUS:85115635317
SN - 2475-0328
VL - 6
SP - 54
EP - 62
JO - Annals of Gastroenterological Surgery
JF - Annals of Gastroenterological Surgery
IS - 1
ER -