The Effect of Preoperative Radiotherapy versus the Immediate Success of Reconstruction Using Microsurgical Jejunum Flap

Reconstruction of the pharyngoesophagus with free jejunal transfer has become the standard technique. Preoperative radiation therapy causes tissue fibrosis and interferes with wound healing. In animal model radiated vessels have higher thrombosis rate. However, clinically it is not clear whether irradiation before surgery will affect the early complications and the success rate of reconstruction. Between April 1998 and April 2003, 46 patients underwent free jejunum flap reconstruction after ablative resection of head and neck cancer at Chang Gung Memorial Hospital in Linkou. All the reconstructions were performed by the same surgeon. Data were collected regarding patients' age and sex, ischemia time, early complications and flap viability. According to whether there was preoperative radiotherapy or not, the patients were divided into two groups. Group Ⅰ had been irradiated. Group Ⅱ had been non-irradiated. All the flaps survived. The early complications such as vascular occlusion and enteral anastomosis leak were compared. There were 22 cases in Group Ⅰwith the complication rate of 22.7%, 24 patients in Group Ⅱ with the complication rate of 20.8%. There was no significant statistical difference. (Chi-square test, p＜0.05) Theoretically pharyngoesophageal reconstruction after radiation therapy is more difficult due to tissue fibrosis and lack of good recipient vessels. But in this series, previous neck irradiation did not appear to have adverse effect on flap viability and complication rate.