Bewirkt der Einsatz frei transplantierter Jejunumsegmente beim fortgeschrittenen Larynx- und Hypopharynxkarzinom eine Lebensverlängerung? Eine matched-pair Analyse*

The effect of free transplanted jejunum autografts, inserted after resection of extensive squamous cell carcinoma of the larynx and hypopharynx is evaluated in terms of survival and the development of local and regional recurrences. In a matched-pair analysis, 22 patients with jejunum transplants were compared with 44 patients with the same performance status, in whom after laryngopharyngectomy, the pharynx had been closed with local mucosa. The cumulative survival rate was calculated using the Kaplan-Meier method; the statistical comparison of the survival curves of the two groups was made with the Mantel-Haezel test. Patients of the study group had a statistically significant (p<=0,01) better survival rate than those of the control group, the 50 % survival rate being 36 and 11 months, respectively. Local recurrences occurred in 9,1 % of the patients in both the study group and in controls, and regional recurrences in 40,8 and 43,2 %, respectively This militates against the possibility that the surgery in patients in whom reconstruction with jejunum was possible might have been more radical. Further, it may be speculated that the statistically significant better survival rate is due to the jejunum itself, presumably to a tumourprotective effect of the lymphatic tissue of the transplant.