Complex Esophageal Reconstruction Procedures Have Acceptable Outcomes Compared With Routine Esophagectomy

Moore, Jessica M.; Hooker, Craig M.; Molena, Daniela; Mungo, Benedetto; Brock, Malcolm V.; Battafarano, Richard J.; Yang, Stephen C.

doi:10.1016/j.athoracsur.2016.02.039

Cited by 11 publications

(10 citation statements)

References 23 publications

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“…According to the literature, colon interposition due to gastric conduit necrosis is recommended only after esophageal diversion and delayed neck reconstruction[66,67]. Esophageal diversion is considered to be a staged damage-control operation in combination with mediastinal drainage, nutritional supplementation via a feeding jejunostomy and antimicrobial therapy.…”

Section: Management Optionsmentioning

confidence: 99%

Conduit necrosis following esophagectomy: An up-to-date literature review

Athanasiou

Hennessy

Spartalis

et al. 2019

WJGS

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Esophageal conduit ischaemia and necrosis is an uncommon but devastating complication of esophagectomy and remains one of the most challenging issues in surgical practice. The incidence, time interval to develop symptoms, and clinical presentation are highly variable with no predictable pattern. Evidence comes from case reports and case series rather than randomized controlled trials. We describe the issues surrounding conduit necrosis affecting the stomach, jejunum and colon as an esophageal replacement and the advantages, disadvantages and challenges of each type of reconstruction. Diagnosis is challenging for the most experienced surgeon. Upper gastrointestinal endoscopy and computed tomography thorax with both oral and intravenous contrast is the gold standard. Management, either conservative or interventional is also a difficult decision. Management options include conservative treatment and more aggressive treatments such as stent insertion, surgical debridement and repair of the esophagus using jejunum, colon or a musculocutaneous flap. In spite of recent advances in surgical techniques, there is no reliable strategy to manage esophageal conduit necrosis. Our review covers the pathophysiology and clinical significance of esophageal necrosis while highlighting current techniques of prevention, diagnosis and treatment of this life-threatening condition.

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Section: Management Optionsmentioning

confidence: 99%

Conduit necrosis following esophagectomy: An up-to-date literature review

Athanasiou

Hennessy

Spartalis

et al. 2019

WJGS

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“…In addition, laparoscopy can provide direct visualization of the substernal dissection (23). However, despite all the advantages of minimally-invasive laparoscopic approach, advanced tumor stage and compromised performance status are associated with higher rates of conversion to open procedure (laparotomy), as in our case (24).…”

Section: Discussionmentioning

confidence: 79%

Laparoscopic-assisted Esophageal Bypass for T4b Esophageal Tumor as a Bridge to Definitive Therapy

Davakis

Syllaios

Mpaili

et al. 2020

In Vivo

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“…Nevertheless, longer grafts are available offering reservoir-like function and less reflux[ 4 , 5 ]. However, a retrospective cohort study comparing complex esophageal reconstruction including 44.7% of patients with other than gastric tube formation to non-complex esophagectomy with direct gastric pull-up reported higher morbidity and longer length of stay for patients in the complex therapy group[ 6 ]. Jejunal grafts are described as suitable primary alternatives for any scope of esophageal replacement, but are accompanied by up to 36% anastomotic leakage and 10% mortality[ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Beware of gastric tube in esophagectomy after gastric radiotherapy: A case report

Yurttas¹,

Wichmann²,

Gani³

et al. 2022

WJCC

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BACKGROUND Gastric tube formation and pull-up is the most common technique of reconstruction following esophagectomy for esophageal cancer. If previous treatment with radiotherapy for gastric mucosa-associated lymphoid tissue (MALT)-lymphoma restricts suitability of the stomach for anastomosis to the esophagus is unknown. CASE SUMMARY A 57-year-old man underwent sequential chemotherapy and radiotherapy for gastric MALT-lymphoma seven years prior to diagnosis of esophageal adenocarcinoma. Esophagectomy without neoadjuvant treatment was recommended by the multidisciplinary tumor board due to early tumor stage [uT1 (sm2) uN+ cM0 according to TNM-classification of malignant tumors, 8 th edition] without lymph node involvement. Minimal invasive esophageal resection with esophagogastrostomy was performed. Due to gastric tube necrosis with anastomotic leakage on the twelfth postoperative day, diverting resection with construction of a cervical salivary fistula was necessary. Rapid recovery facilitated colonic interposition without any complications six months afterwards. CONCLUSION This case report may represent the start for further investigation to know if it is reasonable to refrain from esophagogastrostomy in patients with a long interval between gastric radiotherapy and surgery.

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Complex Esophageal Reconstruction Procedures Have Acceptable Outcomes Compared With Routine Esophagectomy

Cited by 11 publications

References 23 publications

Conduit necrosis following esophagectomy: An up-to-date literature review

Conduit necrosis following esophagectomy: An up-to-date literature review

Laparoscopic-assisted Esophageal Bypass for T4b Esophageal Tumor as a Bridge to Definitive Therapy

Beware of gastric tube in esophagectomy after gastric radiotherapy: A case report

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