Reconstruction of Cervical Esophagus Defects by Free Jejunal Flap After Proximal Esophageal Carcinoma Resections

Background. Surgical treatment of proximal esophageal defects remains one of the greatest challenges to surgeons. Objectives. The aim of this study was to evaluate the free jejunal flap surgical technique and the surgical outcomes in patients who underwent it for proximal esophageal carcinoma resections. Material and Methods. The medical records of nine patients who underwent free jejunal flap reconstruction of the cervical esophagus for proximal esophageal cancer between January 2007 and December 2009 at the Cukurova University Faculty of Medicine, Adana, Turkey, were evaluated retrospectively. The patients' age, gender, symptoms, laboratory findings, diagnostic procedures, stage of disease, pathology, flap viability, length of hospitalization, post-operative ability to swallow, post-operative morbidity, mortality and recurrence were evaluated. The patients were followed up for 11 to 36 months. Results. Although the free jejunal flap technique is a time-consuming and multi-step procedure, all of the free jejunal flaps survived. All of the patients exhibited good post-operative swallowing ability. One patient developed a salivary fistula. There was only one death, resulting from sepsis caused by late diagnosis of displacement of the jejunostomy tube. Conclusions. All the patients regained their capacity to swallow, which improved their quality of life. The free jejunal flap procedure offers rapid rehabilitation and improved quality of life. The study involved only a limited number of patients, but confirmed that with the cooperation of the surgical teams, free jejunal flaps can be used successfully on suitable patients requiring laryngopharyngectomy with cervical esophagectomy (Adv Clin Exp Med 2011, 20, 6, 729-736).