Jejunal esophagoplasty for carcinoma of the esophagus

Abstract

Over a period of 13 years, 1,421 cases of pharyngoesophageal cancer were seen and treated. In 221 patients jejunal replacement of the esophagus—after resection or as bypass—was done. Technically, this procedure was possible in almost all patients including those who were obese. The operative technique must be meticulous as it is much more difficult to handle the small bowel than the colon. The overall hospital mortality was 38.6%. Many survived for more than 30 days, and in 2 the cause of death was malignant cachexia.

Approximately half of the patients (102) underwent bypass operations and the longest survival was 17.4 months. For the remaining 119 pateints who underwent resection and reconstruction, the corrected 5 year survival was 14%.

One method in the reconstruction of the esophagus after resection, or to bypass an unresectable lesion, is to use a loop of jejunum. This was first introducted by Roux in 1907.¹² In the following year, Herzen,⁴ also replaced the esophagus with it. Its use was popularised by Allison and da Silva.¹ 80 cases of jejunoesophagoplasty for benign strictures were reported by Yudin¹⁵ in 1944. Among the adherents to this method of reconstruction were Robertson and Sarjeant,¹¹ and more recently, Meredino.⁶ There are many critics of this procedure. Among these were Garlock³ and Sweet.¹⁴ Both were strong advocates of gastroesophagoplasty. However, the colon has become more popular in the recostruction of the esophagus. But among patients on a diet with the tendency to form bulky stool, its use is not always convenient. Bowel preparation is difficult; the bulky stool keeps on pouring out of the colon during the operation and prevention of contamination of the wound and the peritoneal cavity is virtually impossible. Hence, the use of the jejunum is convenient. Provided the technique is meticulous and the blood supply properly handled, the jejunum can be brought up as high as the pharynx.