Surgery: Esophageal Reconstruction

  • Michio Sato


Esophageal substitutes and reconstruction routes should be considered depending on the location and the extent of the tumor.

Subtotal esophagectomy and esophageal reconstruction with cervical or high intrathoracic anastomosis are generally performed for thoracic esophageal cancer. In Japan, the stomach, colon, and jejunum are used at rates of 86%, 3%, and 6%, respectively, as esophageal substitutes. Esophagogastric anastomotic techniques can largely be classified into hand sewn, circular stapler, and linear stapler techniques.

If the stomach cannot be used, the colon or jejunum with a vascular pedicle is selected as an esophageal substitute. The middle colic artery or ascending branch of the left colic artery is utilized as a vascular pedicle in use of the right or left colon, respectively. In case of a long segment of jejunal flap that cannot reach the neck, vascular anastomosis for supercharge and superdrainage is required to ensure blood supply to the tip of the flap.

Subcutaneous, anterior mediastinal, posterior mediastinal, and intrathoracic reconstruction routes are used, with posterior mediastinal (including intrathoracic) and anterior mediastinal routes preferably selected in Japan at rates of 49% and 38%, respectively.

Free jejunal transfer is selected for reconstruction in cases of cervical esophageal cancer limited to the cervical esophagus. If the cancer extends to the thoracic portion or another tumor is present in the thoracic esophagus, esophageal reconstruction using the stomach or colon is generally performed after transhiatal esophagectomy.


Esophageal reconstruction Gastric tube Colon interposition Free jejunal transfer Esophagogastric anastomosis 


  1. 1.
    Biere SS, van Berge Henegouwen MI, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;379:1887–92.CrossRefGoogle Scholar
  2. 2.
    Mariette C, Markar SR, et al. Hybrid minimally invasive esophagectomy for esophageal cancer. Engl J Med. 2019;380(2):152–62.CrossRefGoogle Scholar
  3. 3.
    van der Sluis PC, van der Horst S, et al. Robot-assisted minimally invasive thoracolaparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer: a randomized controlled trial. Ann Surg. 2019;269(4):621–30.CrossRefGoogle Scholar
  4. 4.
    Tachimori Y, Ozawa S, et al. Comprehensive registry of esophageal cancer in Japan, 2012. Esophagus. 2019;16:221–45.CrossRefGoogle Scholar
  5. 5.
    Takeuchi H, Miyata H, et al. A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg. 2014;260:259–66.CrossRefGoogle Scholar
  6. 6.
    Ando N, Ozawa S, Kitagawa Y, Shinozawa Y, Kitajima M. Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg. 2000;232:225–32.CrossRefGoogle Scholar
  7. 7.
    Japan Esophageal Society. Japanese classification of esophageal cancer, 11th edition: part I. Esophagus. 2017;14:1–36.CrossRefGoogle Scholar
  8. 8.
    Orringer MB, Sloan H. Esophageal replacement after blunt esophagectomy. In: Nyhus LM, Baker RJ, editors. Mastery of surgery, vol. 1. Boston: Little Brown; 2001.Google Scholar
  9. 9.
    Akiyama H. Esophageal anastomosis. Arch Surg. 1973;107:512–4.CrossRefGoogle Scholar
  10. 10.
    Ellis FH Jr, et al. A safe, widely applicable, and expeditious form of palliation for patients with the esophagus and cardia. Ann Surg. 1983;198(4):531–9.CrossRefGoogle Scholar
  11. 11.
    Mathisen DJ, Grillo HC, et al. Transthoracic esophagectomy: a safe approach to carcinoma of 210 the esophagus. Ann Thorac Surg. 1988;45:137–43.CrossRefGoogle Scholar
  12. 12.
    Collard JM, Romagnoli R, et al. Terminalized semimechanical side-to-side suture technique for cervical esophagogastrostomy. Ann Thorac Surg. 1998;65:814–7.CrossRefGoogle Scholar
  13. 13.
    Ercan S, Rice TW, et al. Does esophagogastric anastomotic technique influence the outcome of patients with esophageal cancer? J Thorac Cardiovasc Surg. 2005;129:623–31.CrossRefGoogle Scholar
  14. 14.
    Price TN, Nichols FC, et al. A comprehensive review of anastomotic technique in 432 esophagectomies. Ann Thorac Surg. 2013;95:1154–61.CrossRefGoogle Scholar
  15. 15.
    Orringer MB, Marshall B, Iannettoni MD. Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg. 2000;119:277–88.CrossRefGoogle Scholar
  16. 16.
    Singh D, Maley RH, et al. Experience and technique of stapled mechanical cervical esophagogastric anastomosis. Ann Thorac Surg. 2001;71:419–24.CrossRefGoogle Scholar
  17. 17.
    Furukawa Y, Hanyu N, et al. Usefulness of automatic triangular anastomosis for esophageal cancer surgery using a linear stapler (TA-30). Ann Thorac Cardiovasc Surg. 2005;11:80–6.PubMedGoogle Scholar
  18. 18.
    Noshiro H, Urata M. Triangulating stapling technique for esophagogastrostomy after minimally invasive esophagectomy. Surgery. 2013;154(3):604–10.CrossRefGoogle Scholar
  19. 19.
    Takemura M, Yoshida K, Fujiwara Y. Modified triangulating stapling technique for esophagogastrostomy after esophagectomy for esophageal cancer. Surg Endosc. 2013;27:1249–53.CrossRefGoogle Scholar
  20. 20.
    Toh Y, Sakaguchi Y, et al. The triangulating stapling technique for cervical esophagogastric anastomosis after esophagectomy. Surg Today. 2009;39:201–6.CrossRefGoogle Scholar
  21. 21.
    Valverde A, Hay JM, et al. Manual versus mechanical esophagogastric anastomosis after resection for carcinoma: a controlled trial. Surgery. 1996;120(3):476–83.CrossRefGoogle Scholar
  22. 22.
    Law S, Fok M, et al. Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial. Ann Surg. 1997;226(2):169–73.CrossRefGoogle Scholar
  23. 23.
    Hsu HH, Chen JS, Huang PM, et al. Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma: a prospective randomized controlled trial. Eur J Cardiothorac Surg. 2004;25(6):1097–101.CrossRefGoogle Scholar
  24. 24.
    Saluja SS, Ray S, et al. Randomized trial comparing side-to-side stapled and hand-sewn esophagogastric anastomosis in neck. J Gastrointest Surg. 2012;16(7):1287–95.CrossRefGoogle Scholar
  25. 25.
    Wang WP, Gao Q, et al. A prospective randomized controlled trial of semi-mechanical versus hand-sewn or circular stapled esophagogastrostomy for prevention of anastomotic stricture. World J Surg. 2013;37(5):1043–50.CrossRefGoogle Scholar
  26. 26.
    Hayata K, Nakamori M, et al. Circular stapling versus triangulating stapling for the cervical esophagogastric anastomosis after esophagectomy in patients with thoracic esophageal cancer: a prospective, randomized, controlled trial. Surgery. 2017;162(1):131–8.CrossRefGoogle Scholar
  27. 27.
    Huang C, Xu X, Zhuang B, et al. A comparison of cervical delta-shaped anastomosis and circular stapled anastomosis after esophagectomy. World J Surg Oncol. 2017;15(1):31.CrossRefGoogle Scholar
  28. 28.
    Sugimura K, Miyata H, et al. Comparison of the modified Collard and hand-sewn anastomosis for cervical esophagogastric anastomosis after esophagectomy in esophageal cancer patients: a propensity score-matched analysis. Ann Gastroenterol Surg. 2019;3(1):104–13.CrossRefGoogle Scholar
  29. 29.
    Honda M, Kuriyama A, et al. Hand-sewn versus mechanical esophagogastric anastomosis after esophagectomy: a systematic review and meta-analysis. Ann Surg. 2013;257(2):238–48.CrossRefGoogle Scholar
  30. 30.
    Ascioti AJ, Hofstetter WL, et al. Long-segment, supercharged, pedicled jejunal flap for total esophageal reconstruction. J Thorac Cardiovasc Surg. 2005;130:1391–8.CrossRefGoogle Scholar
  31. 31.
    Sato M, Ando N, Harada H, et al. Vascular pedicled jejunal Roux-en-Y reconstruction with supercharge technique for necrosis of the gastric tube following subtotal esophagectomy. Esophagus. 2007;4:87–90.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Michio Sato
    • 1
  1. 1.Department of SurgeryInternational Goodwill HospitalYokohamaJapan

Personalised recommendations