Baseline motility of the free jejunal graft in a new canine model.

Reconstruction of pharyngoesophageal defects using free jejunal grafts has become an accepted technique of reconstruction. However, there are functional problems associated with the jejunal graft. We developed a canine model that allows us easy access to perform various studies on grafted jejunum, including videofluoroscopy and pressure manometry to determine baseline function. Using a microvascular technique, free jejunal grafts 10 to 30 cm in length were implanted in 11 mongrel dogs. The jejunal segments were implanted subcutaneously and exteriorized proximally and distally. The grafted dogs underwent videofluoroscopic studies. These studies revealed three different types of jejunal graft contractions of variable intensity: circumferential, longitudinal, and mixed. These contractions resulted in four patterns of barium movement: anterograde propulsion, retrograde propulsion, to-and-fro motion, and peristaltic propulsion. Videofluoroscopic studies were repeated on five dogs after an intravenous injection of metoclopramide (Reglan), which caused a significant short-term increase in the intensity of the basic jejunal contractions and barium propulsion. Pressure manometry studies using intraluminal pressure transducers were performed, revealing an inherent baseline contractility. Each dog has its own individual pattern of activity. The pressure generated by the contractions ranged from 5 to 350 mm Hg. Intravenous injection of Reglan produced a marked increase in pressure, but no change in the frequency of contractions. This study suggests that a free jejunal graft will maintain baseline motility. However, this graft may cause dysphagia by discoordination of contractions, retrograde propulsion of a bolus, or a sustained local contraction, demonstrating the clinical problems associated with free jejunal graft reconstruction of the cervical esophagus. Our results with Reglan suggest that it might be possible to improve the function of these grafts using pharmacologic agents.

Treatment of hypopharyngeal carcinoma: a 10-year review of 1,362 cases.

A computer search of cancer patients enrolled in the Rocky Mountain Cancer Data System between 1973 to 1983 revealed 1,362 patients with hypopharyngeal cancer, 1,208 of whom could be staged by the American Joint Committee on cancer staging criteria. Stage I and II patients comprised 17.5% while 71% were either stages III or IV. The distant metastatic rate in advanced stage patients was 24%. Survivals for all treated patients were 65% at 1 year, 33.5% at 3 years, and 25% at 5 years. Three-year survivals were 54.5% for the surgery only group, 41.6% for the combined therapy group, and 17.7% for the irradiation only group. Five-year survivals for the surgery only group were 39.8%, combined therapy, 31.8%, and irradiation only 11.5%. These figures are actuarially corrected. Twenty-two percent of combined therapy patients had preoperative irradiation versus 78% who had postoperative irradiation. There was no statistically significant difference seen between these two groups.