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A Nationwide Survey on Digestive Reconstruction Following Pharyngolaryngectomy With Total Esophagectomy: A Multicenter Retrospective Study in Japan
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...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8786680/ https://www.ncbi.nlm.nih.gov/pubmed/35106415 http://dx.doi.org/10.1002/ags3.12509 |
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author | Okamura, Akihiko Watanabe, Masayuki Mukoyama, Nobuaki Ota, Yoshihiro Shiraishi, Osamu Shimbashi, Wataru Baba, Yoshifumi Matsui, Hidetoshi Shinomiya, Hirotaka Sugimura, Keijiro Morita, Masaru Sakai, Makoto Sato, Hiroshi Shibata, Tomotaka Nasu, Motomi Matsumoto, Shuichi Toh, Yasushi Shiotani, Akihiro |
author_facet | Okamura, Akihiko Watanabe, Masayuki Mukoyama, Nobuaki Ota, Yoshihiro Shiraishi, Osamu Shimbashi, Wataru Baba, Yoshifumi Matsui, Hidetoshi Shinomiya, Hirotaka Sugimura, Keijiro Morita, Masaru Sakai, Makoto Sato, Hiroshi Shibata, Tomotaka Nasu, Motomi Matsumoto, Shuichi Toh, Yasushi Shiotani, Akihiro |
author_sort | Okamura, Akihiko |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8786680 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-87866802022-01-31 A Nationwide Survey on Digestive Reconstruction Following Pharyngolaryngectomy With Total Esophagectomy: A Multicenter Retrospective Study in Japan Okamura, Akihiko Watanabe, Masayuki Mukoyama, Nobuaki Ota, Yoshihiro Shiraishi, Osamu Shimbashi, Wataru Baba, Yoshifumi Matsui, Hidetoshi Shinomiya, Hirotaka Sugimura, Keijiro Morita, Masaru Sakai, Makoto Sato, Hiroshi Shibata, Tomotaka Nasu, Motomi Matsumoto, Shuichi Toh, Yasushi Shiotani, Akihiro Ann Gastroenterol Surg Original Articles 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. John Wiley and Sons Inc. 2021-09-22 /pmc/articles/PMC8786680/ /pubmed/35106415 http://dx.doi.org/10.1002/ags3.12509 Text en © 2021 The Authors. Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Articles Okamura, Akihiko Watanabe, Masayuki Mukoyama, Nobuaki Ota, Yoshihiro Shiraishi, Osamu Shimbashi, Wataru Baba, Yoshifumi Matsui, Hidetoshi Shinomiya, Hirotaka Sugimura, Keijiro Morita, Masaru Sakai, Makoto Sato, Hiroshi Shibata, Tomotaka Nasu, Motomi Matsumoto, Shuichi Toh, Yasushi Shiotani, Akihiro A Nationwide Survey on Digestive Reconstruction Following Pharyngolaryngectomy With Total Esophagectomy: A Multicenter Retrospective Study in Japan |
title | A Nationwide Survey on Digestive Reconstruction Following Pharyngolaryngectomy With Total Esophagectomy: A Multicenter Retrospective Study in Japan |
title_full | A Nationwide Survey on Digestive Reconstruction Following Pharyngolaryngectomy With Total Esophagectomy: A Multicenter Retrospective Study in Japan |
title_fullStr | A Nationwide Survey on Digestive Reconstruction Following Pharyngolaryngectomy With Total Esophagectomy: A Multicenter Retrospective Study in Japan |
title_full_unstemmed | A Nationwide Survey on Digestive Reconstruction Following Pharyngolaryngectomy With Total Esophagectomy: A Multicenter Retrospective Study in Japan |
title_short | A Nationwide Survey on Digestive Reconstruction Following Pharyngolaryngectomy With Total Esophagectomy: A Multicenter Retrospective Study in Japan |
title_sort | nationwide survey on digestive reconstruction following pharyngolaryngectomy with total esophagectomy: a multicenter retrospective study in japan |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8786680/ https://www.ncbi.nlm.nih.gov/pubmed/35106415 http://dx.doi.org/10.1002/ags3.12509 |
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