Factors affecting the patency of the internal jugular vein after neck dissection for malignant hypopharyngeal tumors-Significance of free jejunal flap transfer using the internal jugular vein as the recipient vein.

Abstract

Although preserved internal jugular veins can become occluded after neck dissection, we have not experienced free jejunal flap necrosis when the veins were used as recipient vessels. Thus, we investigated whether using the internal jugular veins as the recipient vessel for free jejunal flap transfer after neck dissection might contribute to postoperative internal jugular vein patency. This retrospective cohort study involved patients who underwent internal jugular vein-preserving neck dissection for hypopharyngeal malignant tumors. We identified and assessed 2 treatment groups: patients with and without preserved internal jugular vein as the recipient vein. To guarantee 80% power for detecting differences between groups using the chi-squared test at a 5% significance level, the enrollment continued until at least 40 patients were included. The primary outcome assessed was internal jugular vein patency on post-contrast computed tomography scans 3 months post-operatively. Preoperative radiation therapy, central venous catheter, left side, and pectoralis major myocutaneous flap reconstruction were included as covariates in the multivariable model. During this period, 123 neck dissections were conducted in 80 eligible patients. Using the internal jugular veins as the recipient vein for free jejunal flap transfer contributed to 19% improvement in patency. Supplemental analysis with additional covariates also showed that patency was significantly improved by 15%. We strongly recommend that the internal jugular veins of the dissected side should be used as the recipient vein to improve postoperative patency of internal jugular veins.