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.
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