Abstract
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.
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 82, 4, and 4 %, 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, a vascular pedicled colon or jejunum is selected as an esophageal substitute. The middle colic artery or ascending branch of the left colic artery is pedicled in use of the right or left colon, respectively. In case of a long segment of the jejunal flap that reaches the cervical region vascular anastomosis for supercharge 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 and anterior mediastinal routes preferably selected in Japan at rates of 36.2 and 33.0 %, respectively.
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Sato, M. (2015). Surgery: Esophageal Reconstruction. In: Ando, N. (eds) Esophageal Squamous Cell Carcinoma. Springer, Tokyo. https://doi.org/10.1007/978-4-431-54977-2_10
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DOI: https://doi.org/10.1007/978-4-431-54977-2_10
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