A Case of Metachronous Primary Hypopharyngeal Cancer, Following Resection of Intra-thoracic Esophageal Cancer, with Reconstruction using a Dertopectral Flap for the Anastomotic Leakage of the Jejuno-gastrostomy

Yoshiki Nakamura, Yutaka Hamabe, Hajime lkuta, Koichi Narita, Tsutomu Shiraishi, Makoto Usami, Masahiro Yamamoto, Yoshikazu Kuroda

First Department of Surgery, Kobe University School of Medicine

A 62-year-old man was admitted to the hospital because of increasing dyspnea. In April 1990, he had undergone intra-thoracic esophagectomy using a gastric tube via the retrosternal route by right thoracotomy for intra-thoracic esophageal cancer. In July 1995 he suffered from worsenig dyspnea and was taken to the hospital. A hypopharyngeal tumor was found at the right piriform recess and a biopsy specimen of the laryngoscopic examination revealed well differentiated squamous cell carcinoma. He underwent a laryngo-pharyngoesophagectomy and radical neck dissection with reconstruction using a free jejunal graft. On the 11th postoperative day, an anastomotic leakage of the jejunogastrostomy occurred. resulting in no improvement in spite of conservertive treatment for two months. Therefore, on December 11, 1995 we repaired the portion of leakage placing a deltopectoral flap between the gastric tube and the jejunal graft. The postoperative course went well and radiography with water soluble contrast material performed two months after operation showed no anastomotic leakage or stenosis of the skin tube. After that, sequestration and curratage was performed three times for the chronic osteomyelitis and the repair of the skin tube-cutaneous fistula was performed twice. In March 1997 the steosis between the skin tube and the gastric tube occurred and reanastosis was performed in April. He discharged from the hospital in May in good condition.

Key words
metachronous primary hypophalyngeal cancer, free jejunal graft, deltopectral flap

Reprint requests
Yoshiki Nakamura First Department of Surgery, Kobe University School of Medicine
7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JAPAN

Accepted
April 22, 1998

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