Safety of radiating jejunal interposition grafts in head and neck cancer

The safety of high-dose postoperative radiation therapy to a jejunal graft has not been established in the literature. The purpose of the present study is to review the effect of postoperative radiation on swallow function in patients who have received a jejunal interposition graft as part of their reconstruction after cancer resection. Charts of patients undergoing hypopharyngeal resections for cancers with placement of jejunal interposition grafts who received postoperative radiation therapy were reviewed. Swallow function was determined from records of patients' subjective characterization of their swallow function, records of weights at each visit, use of gastrostomy tube, need for jejunal dilatation and review of barium swallows. Seventeen patients were identified who had undergone resection of cancers with jejunal interpositions and postoperative radiation therapy. Four patients never regained adequate swallow function postoperatively to allow G-tube removal. The remaining thirteen patients had their G-tubes removed, generally several months after resection, and were able to obtain adequate nutrition orally to maintain or increase their weights. The present series suggests that a segment of jejunum transferred into the neck after laryngopharyngoesophagectomy can be irradiated to high dose with generally acceptable morbidity.