PHARYNGOESOPHAGEAL RECONSTRUCTION WITH THE USE OF VASCULAR ANASTOMOSES - OPERATIVE MODIFICATIONS AND LONG-TERM PROGNOSIS

Objective: Vascular surgical techniques have contributed to the succes s of pharyngoesophageal reconstruction. We report our methods and anal ysis of postoperative complications, quality of life, and long-term pr ognosis. Methods: Sixty-seven patients who underwent pharyngoesophagea l reconstruction with use of vascular anastomoses comprised the study population. The operative procedures performed were free jejunal autog raft transplantation in 54 patients, gastric pedicle placement with va scular anastomoses in 2, jejunal pedicle with vascular anastomoses in 4, colonic pedicle with vascular anastomoses in 4, free jejunal graft and gastric pedicle in 2, and free jejunal graft and jejunal pedicle i n 1. The common carotid artery and internal jugular vein were primaril y used as the recipient vessels. The period of postoperative observati on ranged from 3 days to 145 months. Results: The postoperative compli cations noted were dehiscence in 7 patients, graft failure in 1, wound infection in 2, small bo,vel intussusception in 4, pneumonia in 2, di sseminated intravascular coagulation in 1, and pancytopenia in 1. Reva scularization was successful in all but 1 patient, and oral intake was achieved in 58. Persistent swallowing dysfunction,vas recognized in 4 %. Speech restoration was achieved in 57% of the patients with esophag eal speech in 7% and with an artificial larynx in 50%. In the long-ter m follow-up, 36% of our patients died of the primary disease, 9% died of other diseases, and 55% are alive. Conclusions: Esophageal reconstr uction with the use of vascular anastomoses affords low morbidity and mortality. Postoperative swallowing and speech are satisfactory, and t he function of the reconstructed esophagus is well preserved for as lo ng as 10 years.