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

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• 作者：Itasu Ninomiya ; Kouichi Okamoto…
• 关键词：Esophageal cancer ; Jejunal reconstruction ; Posterior mediastinal route ; Intrathoracic anastomosis
• 刊名：General Thoracic and Cardiovascular Surgery
• 出版年：2014
• 出版时间：October 2014
• 年：2014
• 卷：62
• 期：10
• 页码：627-634
• 全文大小：585 KB
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• 作者单位：Itasu Ninomiya (1)
  Kouichi Okamoto (1)
  Katsunobu Oyama (1)
  Hironori Hayashi (1)
  Tomoharu Miyashita (1)
  Hidehiro Tajima (1)
  Hirohisa Kitagawa (1)
  Sachio Fushida (1)
  Takashi Fujimura (1)
  Tetsuo Ohta (1)
  
  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
  
• ISSN：1863-6713

文摘

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? 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.