Objective: To investigate the survival status of patients with pharyngeal, laryngeal or cervical esophageal cancers, who received free jejunal flap (FJF) to repair the defects following tumor resection, and to analyze the effect of multi-disciplinary treatment on their survival.
Methods: Fifty-eight patients with pharyngeal, laryngeal or cervical esophageal cancer underwent free jejunal flap (FJF) reconstruction after cancer resection between 2010 and 2013. All their clinical records were reviewed and analyzed.
Results: The success rate of flap transplantation was 91.4% (53/58). The 2-year overall survival rates (OSR) of cervical esophageal cancer and hypopharyngeal cancer patients were 67.5% and 49.3%, respectively, both were significantly better than that of laryngeal cancer. The main causes of death were local recurrence and distant metastases. The group with no short-term complications had a better two-year OSR (59.0%) than the group with short-term complications (46.6%), however, the difference between them was not significant (P=0.103). The 2-year survival rate of the initial treatment group was 65.0%, better than that of the salvage treatment group (49.4%), but the difference was not significant (P=0.051). For the stage III and IV patients, the multi-disciplinary treatment group had a significantly better 2-year OSR (64.7%) than the single or sequential treatment group (37.0%, P=0.016).
Conclusions: Free jejunal flap reconstruction is an ideal option for repairing the cervical digestive tract circumferential defects caused by tumor resection with a high success rate and a low mortality. Compared with the single or sequential treatment, multi-disciplinary treatment can significantly improve the survival rate of late-stage hypopharyngeal and cervical esophageal cancer patients.
目的: 探讨咽喉或颈段食管癌切除后同期使用游离空肠瓣(FJF)修复缺损的疗效，以及综合治疗对患者生存的影响。
方法: 回顾性分析2010—2013年间58例咽喉部或颈段食管癌患者的临床资料，58例患者手术时均采用FJF修复。
结果: 58例患者中，术后发生血管危象7例(12.1%)，其中抢救成功2例，FJF坏死5例，FJF手术成功率为91.4%(53/58)。下咽癌患者的2年生存率为49.3%，颈段食管癌患者的2年生存率为67.5%。主要死亡原因是肿瘤局部复发和远处转移。术后无短期并发症组患者的2年生存率(59.0%)高于有短期并发症组(46.6%)，但差异无统计学意义(P＝0.103)。初治组患者的2年生存率(65.0%)高于挽救性治疗组(49.4%)，但差异无统计学意义(P＝0.051)。对于Ⅲ、Ⅳ期患者，综合治疗组患者的2年生存率(64.7%)明显高于单纯和序贯治疗组(37.0%)，差异有统计学意义(P＝0.016)。
结论: FJF手术成功率高、死亡率低，是修复颈部消化道环周缺损的理想方法。与单纯和序贯治疗比较，综合治疗能够显著提高晚期咽喉和颈段食管癌患者的生存率。
Keywords: Hypopharyngeal neoplasms; Esophageal neoplasms; Reconstructive surgical procedures; Survival rate.