Abstract
Pedicled jejunal flap and colon graft interposition are choices for esophageal reconstruction in patients with a history of gastrectomy or those who have undergone synchronous esophagogastrectomy. However, the optimal conduit in this situation is still being debated. We reviewed the literature concerning esophageal reconstruction using a conduit other than the stomach. Approximately 10 % of esophagectomized patients undergo esophageal reconstruction using pedicled jejunum or colon interposition in Japan. The jejunal graft and colon graft are selected evenly, although the percentage of jejunal graft use is gradually increasing. Microvascular supercharge was performed in most of the reports of pedicled jejunal graft reconstruction, whereas vascular enhancement was not popularly used in the reports of colon graft interposition. Although the incidences of graft loss and anastomotic leakage were comparable between grafts, mortality rates seem to be higher in patients who undergo colon graft reconstruction than in those who undergo reconstruction with a jejunal graft. Prospective comparisons of short-term outcomes as well as long-term quality of life are needed to identify the best method of reconstruction.
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Tachimori Y, Ozawa S, Numasaki H, et al. Comprehensive registry of esophageal cancer in Japan, 2007. Esophagus. 2015;12:101–29.
Diseases TJSfE. Comprehensive registry of esophageal cancer in Japan, 1st edn (1988–1994); 2000.
Diseases TJSfE. Comprehensive registry of esophageal cancer in Japan, 2nd edn (1995, 1996, 1997); 2001.
Diseases TJSfE. Comprehensive registry of esophageal cancer in Japan (1998, 1999) and long-term results of esophagectomy in Japan (1998, 1997), 3rd edn; 2002.
Ide H, Ozawa S, Matsubara H, et al. Comprehensive registry of esophageal cancer in Japan, 2000. Esophagus. 2009;6:27–47.
Ozawa S, Tachimori Y, Baba H, et al. Comprehensive registry of esophageal cancer in Japan, 2001. Esophagus. 2009;6:95–110.
Ozawa S, Tachimori Y, Baba H, et al. Comprehensive registry of esophageal cancer in Japan, 2002. Esophagus. 2010;7:7–22.
Ozawa S, Tachimori Y, Baba H, et al. Comprehensive registry of esophageal cancer in Japan, 2003. Esophagus. 2011;8:9–29.
Ozawa S, Tachimori Y, Baba H, et al. Comprehensive registry of esophageal cancer in Japan, 2004. Esophagus. 2012;9:75–98.
Tachimori Y, Ozawa S, Fujishiro M, et al. Comprehensive registry of esophageal cancer in Japan, 2005. Esophagus. 2013;11:1–20.
Tachimori Y, Ozawa S, Fujishiro M, et al. Comprehensive registry of esophageal cancer in Japan, 2006. Esophagus. 2013;11:21–47.
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. 2014;62:627–34.
Longmire WP Jr, Ravitch MM. A new method for constructing an artificial esophagus. Ann Surg. 1946;123:819–35.
DeMeester TR, Johansson KE, Franze I, et al. Indications, surgical technique, and long-term functional results of colon interposition or bypass. Ann Surg. 1988;208:460–74.
Kawano T, Nishikage T, Kawada K, et al. Subcutaneous reconstruction using ileocolon with preserved ileocolic vessels following esophagectomy or in esophageal bypass operation. Dig Surg. 2009;26:200–4.
Bothereau H, Munoz-Bongrand N, Lambert B, et al. Esophageal reconstruction after caustic injury: is there still a place for right coloplasty? Am J Surg. 2007;193:660–4.
Gourley EJ, Gering SA. The meandering mesenteric artery: a historic review and surgical implications. Dis Colon Rectum. 2005;48:996–1000.
Iwata N, Koike M, Kamei Y, et al. Antethoracic pedicled jejunum reconstruction with the supercharge technique for esophageal cancer. World J Surg. 2012;36:2622–9.
Blackmon SH, Correa AM, Skoracki R et al. Supercharged pedicled jejunal interposition for esophageal replacement: a 10-year experience. Ann Thorac Surg. 2012; 94: 1104–1111 (discussion 1111–1103).
Poh M, Selber JC, Skoracki R, et al. Technical challenges of total esophageal reconstruction using a supercharged jejunal flap. Ann Surg. 2011;253:1122–9.
Barzin A, Norton JA, Whyte R, Lee GK. Supercharged jejunum flap for total esophageal reconstruction: single-surgeon 3-year experience and outcomes analysis. Plast Reconstr Surg. 2011;127:173–80.
Doki Y, Okada K, Miyata H, et al. Long-term and short-term evaluation of esophageal reconstruction using the colon or the jejunum in esophageal cancer patients after gastrectomy. Dis Esophagus. 2008;21:132–8.
Ueda K, Kajikawa A, Suzuki Y, et al. Blood gas analysis of the jejunum in the supercharge technique: to what degree does circulation improve? Plast Reconstr Surg. 2007;119:1745–50.
Ascioti AJ, Hofstetter WL, Miller MJ, et al. Long-segment, supercharged, pedicled jejunal flap for total esophageal reconstruction. J Thorac Cardiovasc Surg. 2005;130:1391–8.
Chana JS, Chen HC, Sharma R et al. Microsurgical reconstruction of the esophagus using supercharged pedicled jejunum flaps: special indications and pitfalls. Plast Reconstr Surg. 2002; 110:742–748 (discussion 749–750).
Maier A, Pinter H, Tomaselli F, et al. Retrosternal pedicled jejunum interposition: an alternative for reconstruction after total esophago-gastrectomy. Eur J Cardiothorac Surg. 2002;22:661–5.
Kesler KA, Pillai ST, Birdas TJ et al. “Supercharged” isoperistaltic colon interposition for long-segment esophageal reconstruction. Ann Thorac Surg. 2013; 95:1162–1168 (discussion 1168–1169).
Saeki H, Morita M, Harada N, et al. Esophageal replacement by colon interposition with microvascular surgery for patients with thoracic esophageal cancer: the utility of superdrainage. Dis Esophagus. 2013;26:50–6.
Hamai Y, Hihara J, Emi M, et al. Esophageal reconstruction using the terminal ileum and right colon in esophageal cancer surgery. Surg Today. 2012;42:342–50.
Klink CD, Binnebosel M, Schneider M, et al. Operative outcome of colon interposition in the treatment of esophageal cancer: a 20-year experience. Surgery. 2010;147:491–6.
Mine S, Udagawa H, Tsutsumi K, et al. Colon interposition after esophagectomy with extended lymphadenectomy for esophageal cancer. Ann Thorac Surg. 2009;88:1647–53.
Motoyama S, Kitamura M, Saito R, et al. Surgical outcome of colon interposition by the posterior mediastinal route for thoracic esophageal cancer. Ann Thorac Surg. 2007;83:1273–8.
Shirakawa Y, Naomoto Y, Noma K, et al. Colonic interposition and supercharge for esophageal reconstruction. Langenbecks Arch Surg. 2006;391:19–23.
Briel JW, Tamhankar AP, Hagen JA et al. Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg. 2004; 198:536–541 (discussion 541–532).
Davis PA, Law S, Wong J. Colonic interposition after esophagectomy for cancer. Arch Surg. 2003;138:303–8.
Furst H, Huttl TP, Lohe F, Schildberg FW. German experience with colon interposition grafting as an esophageal substitute. Dis Esophagus. 2001;14:131–4.
Hagen JA, DeMeester SR, Peters JH et al. Curative resection for esophageal adenocarcinoma: analysis of 100 en bloc esophagectomies. Ann Surg. 2001; 234:520–530 (discussion 530–521).
Kolh P, Honore P, Degauque C, et al. Early stage results after oesophageal resection for malignancy—colon interposition vs. gastric pull-up. Eur J Cardiothorac Surg. 2000;18:293–300.
Zehetner J, DeMeester SR, Alicuben ET, et al. Intraoperative assessment of perfusion of the gastric graft and correlation with anastomotic leaks after esophagectomy. Ann Surg. 2015;262:74–8.
Yukaya T, Saeki H, Kasagi Y, et al. Indocyanine green fluorescence angiography for quantitative evaluation of gastric tube perfusion in patients undergoing esophagectomy. J Am Coll Surg. 2015;221:e37–42.
Meyerson SL, Mehta CK. Managing complications II: conduit failure and conduit airway fistulas. J Thorac Dis. 2014; S364–S371.
Stephens EH, Gaur P, Hotze KO, et al. Super-charged pedicled jejunal interposition performance compares favorably with a gastric conduit after esophagectomy. Ann Thorac Surg. 2015;100:407–13.
Yildirim S, Koksal H, Celayir F, et al. Colonic interposition vs. gastric pull-up after total esophagectomy. J Gastrointest Surg. 2004;8:675–8.
Greene CL, DeMeester SR, Augustin F et al. Long-term quality of life and alimentary satisfaction after esophagectomy with colon interposition. Ann Thorac Surg 2014; 98:1713–1719 (discussion 1719–1720).
Cense HA, Visser MR, van Sandick JW, et al. Quality of life after colon interposition by necessity for esophageal cancer replacement. J Surg Oncol. 2004;88:32–8.
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Watanabe, M., Mine, S., Nishida, K. et al. Reconstruction after esophagectomy for esophageal cancer patients with a history of gastrectomy. Gen Thorac Cardiovasc Surg 64, 457–463 (2016). https://doi.org/10.1007/s11748-016-0661-0
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DOI: https://doi.org/10.1007/s11748-016-0661-0