Outcome of free jejunal transfer using the end-to-side arterial anastomosis technique as a pharyngo-oesophageal substitute: A 15-year experience

Objectives: Free jejunal transfer (FJT) has been preferentially used for pharyngo-oesophageal reconstruction. The success of FJT typically depends on the security of the vascular anastomoses. Arterial anastomosis is usually performed in an end-to-end fashion, with the exception of cases lacking an adequate donor artery due to radiation therapy or infection. At our institution, end-to-side arterial anastomosis to the common carotid artery has been successfully used in FJT for both primary and secondary cervical pharyngooesophageal reconstruction. Methods: From 1995 to 2010, 41 FJTs were performed by end-to-side arterial anastomosis in 39 patients. Medical records and the follow-up data were retrospectively reviewed. Results: Thirty-one patients underwent FJT for cancer, 7 for corrosive injury, and 1 for perforation by a foreign body. The graft survival rate was 90.2% (37of 41). The jejunal mesenteric artery was anastomosed in an end-to-side manner to the common carotid artery in 39 cases, and to the innominate artery in 2. The mesenteric vein was likewise anastomosed in an end-to-side manner to the internal jugular vein in 36 cases and to the innominate vein in 2. In 3 cases, the mesenteric vein was anastomosed to the external jugular vein in an end-to-end manner. Graft failure occurred in 4 patients due to venous thrombosis (3 cases) or arterial rupture due to uncontrolled infection (1 case). Two of these patients underwent redo FJT, while the remaining two underwent gastric pull-up surgery after removal of the graft. Conclusions: FJT is a good option for primary or secondary reconstruction of pharyngo-oesophageal defects. End-to-side arterial anastomoses in FJT can be successfully performed without sacrificing the recipient artery.