Swallowing Outcomes of Hypopharyngeal Reconstruction with Free Jejunal Flap - Retrospective Statistical Analysis of 83 Consecutive Cases in Japanese Single Institution -

[Introduction] Total pharyngo-laryngo-esophagectomy (TPLE) and free jejunal flap (FJ) reconstruction has been a widely used procedure for extensive hypopharyngeal or laryngeal cancer. There are several reports that assess swallowing outcomes of hypopharyngeal reconstruction with FJ flap. Pre/postoperative irradiation, chemotherapy and resection of lateral retropharyngeal (Rouviere) lymph nodes are known factors to influence postoperative swallowing outcomes in Caucasian people. However, to date, little is known regarding the influential factors in Asian people. In the current report, we retrospectively analyze postoperative functional outcome of patients in one institution in Japan and statistically assessed influential factors for swallowing outcome.

[Patients and Methods] From January of 2007 to October of 2017, 83 cases that underwent FJ transfer for hypopharyngeal reconstruction in Nagoya University hospital are included in the study. The patients were 58 males and 25 females, with a mean age at the operation of 66.2 years. Indication for the operation included 67 hypopharyngeal cancers, 10 laryngeal cancers and 6 esophageal stenoses due to irradiation or operative scar formation. Pre/postoperative chemoradiotherapy, operative technique as well as postoperative complication are listed for possible influential factors associated with postoperative outcomes. Swallowing functions were extracted from medical records. Statistical analysis was performed utilizing (SAS 9.4, SAS Institute, United States), and univariate regression analysis as well as multivariate regression analysis were performed. P value under 0.05 was considered as statistically significant.

[Results] FJ flap failure resulted from venous thrombosis in one patient and was rescued with staged pectoralis major flap transfer. 3 months post-operatively, 55.6 % of patients could tolerate normal diet. This rate was 66.1 % at 6 months and 76.9 % at 12 months after the operation. Anastomotic stapler was found to be a risk factor for dysphagia at 3 and 6 months postoperatively, but was not a risk factor at 12 months. Neither preoperative nor postoperative radiotherapy was found to be risks for dysphagia.

[Discussion]Swallowing outcome is a result of a complex relationship of multiple factors such as age, pre/postoperative chemoradiotherapy, surgical intervention and rehabilitation. In this study, the anastomotic stapler was found to be a risk factor for dysphagia in the early postoperative phase; however, this relationship disappeared at one year. Balloon dilation procedure or rehabilitation might have improved the outcome during the course. These analysis may help to improve operative procedure to achieve best postoperative functional outcome.