Abstract
Background
The stomach is not available as a reconstruction organ in previously and synchronously gastrectomized esophageal cancer patients. In these patients, a pedicled jejunum or colon is mainly used for the reconstruction organ instead of the stomach, however, its reconstruction procedure is different among the institutes. In our department, a two-stage operation using a free jejunal flap (FJF) is performed when the stomach is unavailable.
Methods
A two-stage operation using a FJF for gastrcectomized esophageal cancer performed between 2010 and 2016 were retrospectively analyzed to evaluate a safety and feasibility of our operation.
Results
A two-stage operation using a FJF was performed for 30 cases, 19 for previously gastrectomized cases, and 11 for synchronous cases, respectively. Among 30 cases, thoracic and cervical esophageal cancer cases were 25 and 5, respectively. For 25 cases of the thoracic esophageal cancer, a subtotal esophagectomy, making a cervical esophagostomy and a jejunal tube placement was performed at the first stage, a reconstruction through the subcutaneous route using a FJF with vascular anastomoses by plastic surgeons was performed at the second stage. Median operation time of first and 2nd stage was 334 and 503 minutes, respectively. An internal thoracic artery was used for a recipient artery in all cases. In 4 of 5 cases of cervical esophageal cancer, a subtotal esophagectomy, esophago-jejuno anastomosis, making a jejunostoma using a FJF was performed at the first stage, the reconstruction of the anal side of a jejunostoma was performed by using a pedicled intestine at the second stage. Median operation time of first and second stage was 640 and 260 minutes, respectively. Clavien-Dindo grade IIIb or IV postoperative complication was seen in 3 cases (10%) after the first stage, 3 cases (10%) after the second stage. Necrosis of a FJF and anastomotic leakage was seen in 0 (0%) and 5 cases (17%), respectively.
Conclusion
A two-stage operation using a FJF needs plastic surgeon's cooperation, but is considered to be safe and feasible operation when a stomach is not available.
Disclosure
All authors have declared no conflicts of interest.
Thoracoscopic esophagectomy with left recurrent laryngeal nerve monitoring for thoracic esophageal cancer in a patient with a right aortic arch: a case report