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Feasibility of esophageal reconstruction using a pedicled jejunum with intrathoracic esophagojejunostomy in the upper mediastinum for esophageal cancer

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Abstract

Objective

An alternative conduit is needed when the gastric tube cannot be used as an esophageal substitute for reconstruction after esophagectomy. We adopted pedicle jejunal reconstruction with intrathoracic anastomosis in the upper mediastinum under such circumstances. The aim of this study was to evaluate the feasibility of this technique.

Methods

Two hundred and ten patients with esophageal cancer underwent esophagectomy and reconstruction from 1998 to 2013. Among them, 6 patients underwent colon interposition (colon group) and 13 underwent jejunum reconstruction (jejunum group) including 8 thoracoscopic anastomosis. The operative results of both groups were compared with those of 191 gastric tube reconstructions (stomach group).

Results

The operative times in the colon and jejunum groups were significantly longer than that in the stomach group (P = 0.001 and P = 0.018, respectively). The colon group showed more operative blood loss and more frequent anastomotic leakage and ischemic stenosis of the conduit than did the stomach group (1605 vs. 530 g, P = 0.007; 50 vs. 12.6 %, P = 0.035; 16.7 vs. 0 %, P = 0.03, respectively). There was no anastomotic leakage, conduit necrosis and mortality in the jejunum group. Ischemic stenosis of the conduit occurred more frequently in jejunum group than in the stomach group (23.1 vs. 0 %, P < 0.001). However, the stenosis could be managed safely with endoscopic treatment. Patient survival in the colon and jejunum groups was consistent with that in the stomach group.

Conclusions

Pedicle jejunal reconstruction with intrathoracic anastomosis can be performed safely under thoracotomy or thoracoscopic surgery when stomach cannot be used as an esophageal substitute after esophagectomy.

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Acknowledgments

The authors thank Prof. Osugi of Osaka City University for the helpful advice regarding creation of the jejunal conduit.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Gastroenterologic Surgery, Department of Oncology, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan

    Itasu Ninomiya, Kouichi Okamoto, Katsunobu Oyama, Hironori Hayashi, Tomoharu Miyashita, Hidehiro Tajima, Hirohisa Kitagawa, Sachio Fushida, Takashi Fujimura & Tetsuo Ohta

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  1. Itasu Ninomiya
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  2. Kouichi Okamoto
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  3. Katsunobu Oyama
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  4. Hironori Hayashi
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  5. Tomoharu Miyashita
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  6. Hidehiro Tajima
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  7. Hirohisa Kitagawa
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  8. Sachio Fushida
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  9. Takashi Fujimura
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  10. Tetsuo Ohta
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Correspondence to Itasu Ninomiya.

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Ninomiya, I., Okamoto, K., Oyama, K. et al. Feasibility of esophageal reconstruction using a pedicled jejunum with intrathoracic esophagojejunostomy in the upper mediastinum for esophageal cancer. Gen Thorac Cardiovasc Surg 62, 627–634 (2014). https://doi.org/10.1007/s11748-014-0435-5

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  • DOI: https://doi.org/10.1007/s11748-014-0435-5

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