815. FREE JEJUNAL GRAFT (FJG) FOR COMPLEX RECONSTRUCTION AFTER PHARINGO-LARINGO-ESOPHAGECTOMY
Authors: Caballero Javier Martínez , Cuéllar Elias Rodríguez , Bletrán Pablo Vázquez , Gavilanes-Plasencia Javier , González Esther García , Pena Israel Iglesias , Torrado Cristina Alegre , Rodríguez Pilar Gómez , Herrero Eduardo Ferrero 
Published: September 2024

Abstract

Background
Pharyngo-esophageal reconstruction using free jejunal grafts has been widely used for the treatment of locally advanced carcinomas of the hypopharynx and cervical esophagus. However, the procedure is technically demanding and requires complex recontractions. The aim of this study was to evaluate our institutional outcomes of reconstruction using a free jejunal graft with vascular reconstruction in patients undergoing pharyngo laryngo esophagectomy with a multidisciplinary surgical team.

Material and methods
Unicentric retrospective case series between 2014-2023 with 6 patients that require complex reconstruction with free jejunal graft. Information was obtained from institutional database.
Quantitative variables are expressed with median and interquartile range (IQR), and qualitative variables with percentage and absolute number.

Results
In our sample, all patients were male with median age of 62 (7) years old and had previous history of squamous cell carcinoma (SCC) treated with radical Qt/Rt with maximum radiotherapy dose who developed local recurrence at hypopharynx involving the cervical esophagus. Patients demographics and characteristics are shown in table 1.
FJG was the primary procedure in five cases after PLPE, of which three were done as curative procedure and the rest as a palliative procedure. In one patients FJG was considered after gastric tube reconstruction with transhiatal esophagectomy.
JFG vessels were commonly anastomosed to the common superior thyroid artery (42,9%) and the external jugular vein (21%) and thyroid vein (21,2%). Operative time was 440 (359) minutes. After FJG procedure time to oral intake reintroduction was 7 (6-20) days and hospital stay length was 20,5 (16) days.
Pneumonia was the most frequent complication in four patients (57,2%). Leakage rate after FJG was 33% (2). Three patients required reintervention, (1) mesenteric graft bleeding, (1) graft anastomoses dehiscence and (1) graft necrosis.
FJG failure rate was 33%, one due complete graft ischemia secondary to arterial thrombosis at 2nd POD and other due to failed conversative management of dehiscence of both anastomoses with partial ischemia.
After failed FJG only one patient underwent reconstruction by transhiatal esophagectomy and gastric tube replacement.
Two patients were readmitted before 30 days and two patients before 12 months after discharge.
BMI after JFG was 22.7 (13,1) kg/m2. According to late complication, dysphagia was the most common complication (42,7%) also one patient cannot feed orally due to severe stenosis after chronic fistula.
In-patient mortality was 0%. Overall survival was 19 (37) months. One patient with FJG failure died due to septic complications after pharingostoma, and one patient due to disease progression.

Conclusion
Free jejunal graft with vessel reconstruction for patients undergoing pharyngo-laryngo-esophagectomy is a safe procedure but with high complications rate which enhance the priority of centralize this pathology in high volume centers.