Background: Free jejunal transfer (FJT) is a standard method of reconstruction after total pharyngo-laryngo-cervical esophagectomy (TPLE) in patients with advanced head and neck cancer. However, it is related to various degrees of postoperative swallowing dysfunction. This study aimed to assess whether the tensed and straight FJT method results in a reduced rate of postoperative dysphagia compared with historical controls. Methods: Patients who were undergoing FJT after TPLE for squamous cell carcinoma of the hypopharynx or cervical esophagus were enrolled. The primary endpoint was the rate of not developing dysphagia within 6 months of the surgery, and we compared this value with that obtained from historical data of patients who underwent FJT. The secondary endpoint was the rate of developing surgical complications. Results: Although 128 patients were registered between August 2012 and July 2015, 7 were excluded based on the exclusion criteria. Of the remaining 121 patients, FJT with the craniocaudally tensed and straight method was performed in all patients. The rate of not developing dysphagia and its 95% confidence interval (CI) were 66.1% and 57.0–74.5%, respectively. The lower limit of the CI was higher than the prespecified threshold value of 50.0%. The rate of developing complications of total necrosis of the jejunum was 3.3%, cervical infection was 9.9%, and major anastomotic leakage was 4.1%. Conclusions: Our findings revealed that the proportion of postoperative dysphagia decreased in patients who underwent tensed and straight FJT. This method may become the standard surgical method in reconstruction of defects after TPLE.

国立がんセンター頭頸部外科における舌部分切除例142例について検討し, 口内法による舌部分切除例の治療成績を明らかにするとともに pull-through 法の適応について考察した。口内法による舌部分切除術施行例130例の累積生存率は81%だった。口内法による舌部分切除術施行例のうち局所再発例は13例に認め, そのうち舌根再発は4例, 口腔底再発は5例であった。これら9例は pull-through 法での切除により再発を避けることが出来た可能性があると考えた。pull-through 法12例のうち深部再発例は1例のみであった。以上のことから舌部分切除症例のなかで舌根および口腔底へ深部浸潤する症例は pull-through 法のよい適応となると考えた。その他, 大半の舌部分切除術は口内法で充分に施行可能と考えた。

舌癌405例 (70歳未満341例, 70歳以上64例) を対象として, 両群を比較し高齢者舌癌の臨床像を検討した。70歳以上の症例では治療に影響を及ぼしうる既往歴を有する患者は76%と多かった。また70歳以上の症例の死因では他病死 (40%), 他癌死 (23%) が多くを占めた。しかしながら, 年齢による症例の分布, 術式の適応を含めた治療の概要, 死因特異的生存率に差を認めなかった。舌癌治療の選択においては実際の年齢だけでなく, 基礎疾患の有無, 患者や家族の希望, 社会的背景を念頭においた判断が重要と考えた。