Work

Nonsupercharged cervical Roux-en-Y esophagojejunostomy for esophageal reconstruction

Year: 2025

Type: article

Abstract: Objective: To explore whether the use of nonsupercharged jejunum as a substitute for esophagus is feasible among select patients involved in esophageal reconstruction. Methods: Twenty-two cases of nonsupercharged cervical Roux-en-Y esophagojejunostomy from January 2021 to April 2025 by 1 medical team in our center were analyzed. We typically preserved the first jejunal arterial branch and divided the second and third jejunal branches. Roux-en-Y esophagojejunostomy was performed without cervical microvascular anastomosis. Patient demographic data, perioperative characteristics, quality of life at 6 months postoperatively and survival outcome were recorded. Results: Of the 22 cases reported, 19 patients were men with median age of 69 years (range, 53-80 years). The most common cause of the use of jejunal conduit was unavailability of gastric conduit (n = 18 [81.8%]) due to prior gastrectomy followed by the necrosis of colonic graft (n = 2 [9.1%]) and gastric conduit (n = 2 [9.1%]). The median operation time was 270 minutes (range, 150-491 minutes). The median duration of postoperative hospital stay was 11 days (range, 5-42 days) with 5 days (range, 1-37 days) in the intensive care unit. There were 4 (18.2%) cases of anastomotic leakage. None of the patients experienced necrosis of the jejunal afferent loop. All patients, except for 1, reported good oral feeding postsurgery. One patient died within 3 months after surgery due to anastomotic leakage and iatrogenic jejunal conduit perforation. The patient-reported quality of life outcome showed high scores in global health status and low scores in symptom. The postoperative 1- and 2-year overall survival rate was 0.802 (95% CI, 0.624-1.000) and 0.501 (95% CI, 0.277-0.907), respectively. Conclusions: A cervical Roux-en-Y esophagojejunostomy without cervical microvascular anastomosis is a safe and feasible approach among select patients, especially for those who have undergone upper gastrointestinal tract reconstruction, such as Roux-en-Y, Billroth I reconstruction, Billroth II reconstruction, or jejunostomy.

Source: JTCVS Techniques

DOI: 10.1016/j.xjtc.2025.10.017