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Yokota K, Kitagawa H, Namikawa T, Utsunomiya M, Seo S. A case of delayed necrosis of reconstructed colon after esophagectomy. Clin J Gastroenterol 2024:10.1007/s12328-024-02009-7. [PMID: 38918307 DOI: 10.1007/s12328-024-02009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 06/21/2024] [Indexed: 06/27/2024]
Abstract
We report a very rare case of delayed necrosis of the reconstructed colon 6 months after esophagectomy.A 67-year-old male patient had undergone esophagectomy with gastric tube reconstruction for esophageal cancer in 2014. Subsequently, total gastrectomy and ileo-colon reconstruction via a retrosternal route was performed for gastric tube cancer in 2022. Six months later, he suffered acute chest pain and came to our hospital. Contrast-enhanced CT showed severe dilation of the reconstructed colon with poor enhancement of the wall opposite mesentery, without arterial obstruction. Endoscopy showed no ischemic changes in the esophago-ileum anastomosis; however, mucosal color change to black was observed in the reconstructed colon. We diagnosed ischemic colitis of the reconstructed colon and started conservative treatment; however, 18 days later, he developed a right pyothorax due to perforation of the reconstructed colon. We performed necrosed colectomy with right chest drainage and cervical esophageal fistula was made. Histopathological examination revealed mucosal detachment, thinning of the muscularis propria, and ghost-like appearance of crypt. If necrosis of the reconstructed colon is suspected in the late postoperative period, endoscopic findings of the colonic mucosa may be useful in determining surgical treatment, even in the absence of arterial blood flow obstruction.
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Affiliation(s)
- Keiichiro Yokota
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Masato Utsunomiya
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Satoru Seo
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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Maeda Y, Minagawa N, Okada N, Kato T, Saito A, Takemoto K. Salvage reconstruction of the esophagus using the left colon with microscopic supercharge following failed ileocolic reconstruction: A case report. Int J Surg Case Rep 2024; 116:109377. [PMID: 38367417 PMCID: PMC10943980 DOI: 10.1016/j.ijscr.2024.109377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION Ileocolic interposition is often used for the reconstruction of patients with esophageal cancer with a history of gastrectomy. However, graft failure due to conduit necrosis has been reported in 0-5 % of patients. Salvage reconstruction surgery for this situation is considered challenging, and only a few cases of successful salvage operations following failure of ileocolic interposition have been reported. PRESENTATION OF CASE A 70s year-old male patient with a history of distal and total gastrectomy underwent subtotal esophagectomy for esophageal cancer. Reconstruction using a pedicled ileocolic interposition was performed; however, the ileocolic graft failed. After recovery of the nutritional status, salvage reconstruction was planned. Due to a history of Roux-en-Y reconstruction for gastric cancer, jejunal reconstruction was not considered feasible. Therefore, salvage reconstruction was performed using left colon interposition with microscopic supercharge and superdrainage anastomosis. The graft was pedicled by the left colic artery and the inferior mesenteric vein, and microscopic anastomosis was performed between the intrathoracic and middle colic vessels. The patient recovered without major complications and retained the ability to consume normal food. DISCUSSION Microscopic supercharge and superdrainage vascular anastomosis have been reported to ensure augmented blood flow. This is the first case report of successful salvage reconstruction using the left colon interposition technique following failure of ileocolic interposition for esophageal cancer. CONCLUSION We report a case of salvage reconstruction using left colon interposition with microscopic supercharge and superdrainage anastomosis following failure of ileocolic reconstruction for esophageal cancer.
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Affiliation(s)
- Yoshiaki Maeda
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, 3-54 Kikusui, Shiroishi-ku, Sapporo, 003-0804, Japan.
| | - Nozomi Minagawa
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, 3-54 Kikusui, Shiroishi-ku, Sapporo, 003-0804, Japan.
| | - Naoki Okada
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, 3-54 Kikusui, Shiroishi-ku, Sapporo, 003-0804, Japan.
| | - Takuya Kato
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, 3-54 Kikusui, Shiroishi-ku, Sapporo, 003-0804, Japan
| | - Akira Saito
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, 3-54 Kikusui, Shiroishi-ku, Sapporo, 003-0804, Japan
| | - Konomi Takemoto
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, 3-54 Kikusui, Shiroishi-ku, Sapporo, 003-0804, Japan
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3
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Kitadani J, Ojima T, Hayata K, Goda T, Takeuchi A, Katsuda M, Tominaga S, Fukuda N, Nakai T, Nagano S, Yamaue H. Nutritional benefit of remnant gastric preservation in patients with esophageal cancer undergoing radical esophagectomy and ileo-colon interposition. BMC Surg 2022; 22:255. [PMID: 35780102 PMCID: PMC9250726 DOI: 10.1186/s12893-022-01704-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/24/2022] [Indexed: 12/04/2022] Open
Abstract
Background This retrospective study aimed to investigate the short-term surgical outcomes and nutritional status of ileo-colon interposition in patients with esophageal cancer who could not undergo gastric tube reconstruction. Methods Sixty-four patients underwent subtotal esophagectomy with reconstruction using ileo-colon interposition for esophageal cancer at the Wakayama Medical University Hospital between January 2001 and July 2020. Using propensity scores to strictly balance the significant variables, we compared treatment outcomes. Results Before matching, 18 patients had cologastrostomy and 46 patients had colojejunostomy. After matching, we enrolled 34 patients (n = 17 in cologastrostomy group, n = 17 in colojejunostomy group). Median operation time in the cologastrostomy group was significantly shorter than that in the colojejunostomy group (499 min vs. 586 min; P = 0.013). Perforation of the colon graft was observed in three patients (7%) and colon graft necrosis was observed in one patient (2%) in the gastrojejunostomy group. Median body weight change 1 year after surgery in the cologastrostomy group was significantly less than that of the colojejunostomy group (92.9% vs. 88.5%; P = 0.038). Further, median serum total protein level 1 year after surgery in the cologastrostomy group was significantly higher than that of the colojejunostomy group (7.0 g/dL vs. 6.6 g/dL, P = 0.030). Conclusions Subtotal esophagectomy with reconstruction using ileo-colon interposition is a safe and feasible procedure for the patients with esophageal cancer in whom gastric tubes cannot be used. Cologastrostomy with preservation of the remnant stomach had benefits in the surgical outcomes and the postoperative nutritional status. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01704-x.
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Affiliation(s)
- Junya Kitadani
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Toshiyasu Ojima
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
| | - Keiji Hayata
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Taro Goda
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Akihiro Takeuchi
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Masahiro Katsuda
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Shinta Tominaga
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Naoki Fukuda
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Tomoki Nakai
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Shotaro Nagano
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
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Yurttas C, Wichmann D, Gani C, Bongers MN, Singer S, Thiel C, Koenigsrainer A, Thiel K. Beware of gastric tube in esophagectomy after gastric radiotherapy: A case report. World J Clin Cases 2022; 10:5854-5860. [PMID: 35979123 PMCID: PMC9258348 DOI: 10.12998/wjcc.v10.i17.5854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/11/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
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, 8th 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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Affiliation(s)
- Can Yurttas
- Department of General, Visceral and Transplant Surgery, University Hospital of Tuebingen, Tuebingen 72076, Germany
| | - Doerte Wichmann
- Department of General, Visceral and Transplant Surgery, University Hospital of Tuebingen, Tuebingen 72076, Germany
| | - Cihan Gani
- Department of Radiooncology, University Hospital of Tuebingen, Tuebingen 72076, Germany
| | - Malte N Bongers
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen 72076, Germany
| | - Stephan Singer
- Department of Pathology, University Hospital of Tuebingen, Tuebingen 72076, Germany
| | - Christian Thiel
- Department of General, Visceral and Transplant Surgery, University Hospital of Tuebingen, Tuebingen 72076, Germany
| | - Alfred Koenigsrainer
- Department of General, Visceral and Transplant Surgery, University Hospital of Tuebingen, Tuebingen 72076, Germany
| | - Karolin Thiel
- Department of General, Visceral and Transplant Surgery, University Hospital of Tuebingen, Tuebingen 72076, Germany
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Yang Y, Ma L. Oesophageal reconstruction with a reversed gastric conduit for a complex oesophageal cancer patient: a case report. BMC Surg 2022; 22:225. [PMID: 35690775 PMCID: PMC9188175 DOI: 10.1186/s12893-022-01630-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/04/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The gastric conduit is the best replacement organ for oesophageal reconstruction, but a reversed gastric conduit (RGC) is rare. Oesophageal reconstruction for oesophageal cancer patients with a previous history of complicated gastrointestinal surgery is rather difficult. Here, we report a case in which oesophageal reconstruction was successfully managed using RGC based solely on the left gastroepiploic artery supply. CASE PRESENTATION A 69-year-old man with oesophageal cancer had a history of endoscopic intestinal polypectomy and pylorus-preserving pancreaticoduodenectomy (PPPD). The right gastroepiploic artery and right gastric artery had been completely severed. The only supply artery that could be used for the gastric conduit was just the left gastroepiploic artery. Because of the complex history of abdominal surgery, we had no choice but to use the RGC to complete the oesophageal reconstruction, in which the gastric conduit was passed reversely through the hiatus to the oesophageal bed and layered end-to-side manual intrathoracic anastomosis with the esophagus. The patient had transient feeding problems with postoperative delayed thoracic stomach emptying but no anastomotic stenosis or thoracic stomach fistula. He was satisfied with his life and had no long-term complications. There was no significant effect on gut physiological function, and RGC could work normally. CONCLUSIONS Oesophageal reconstruction with RGC is a feasible procedure for complex oesophageal carcinoma that can simplify complicated surgical procedures, has less influence on gut function, is less invasive, and is safe.
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Affiliation(s)
- Yanbo Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Sichuan, 610041, Chengdu, People's Republic of China.,Chest Oncology Institute, West China Hospital, Sichuan University, Chengdu, China.,Western China Collaborative Innovation Centre for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Lin Ma
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Sichuan, 610041, Chengdu, People's Republic of China. .,Chest Oncology Institute, West China Hospital, Sichuan University, Chengdu, China. .,Western China Collaborative Innovation Centre for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China.
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6
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Akutsu T, Fujita T, Kajiyama D, Ozaki A, Sato K, Fujiwara H, Kojima T, Daiko H. Operative outcomes and long-term survival of patients undergoing colon interposition after esophagectomy for cancer. Thorac Cancer 2022; 13:844-852. [PMID: 35088520 PMCID: PMC8930463 DOI: 10.1111/1759-7714.14332] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/30/2022] Open
Abstract
Background The first choice of an esophageal substitute after esophagectomy for cancer is the stomach. However, the colon must be considered for reconstruction in specific situations. The purpose of this study was to clarify the frequency and clinical features of patients who underwent colon interposition in thoracic esophagectomy and to investigate the postoperative complications and survival. Methods We conducted a retrospective case–control study in the National Cancer Center Hospital East, Japan. Patients who underwent colon interposition after esophagectomy for cancer between 2010 and 2020 were analyzed. Results Eighty‐eight patients underwent esophagectomy with colon interposition; 53.2% received preoperative treatment and 52.3% underwent thoracoscopic surgery. Clavien–Dindo grade >III postoperative complications occurred in 42% of the patients; anastomotic leakage was the most common complication, occurring in 26.1% of the cases. Univariate analysis of the factors associated with Clavien–Dindo grade <III complications showed that the period 2015–2020 and totally mechanical Collard anastomosis were significant factors, with odds ratios (OR) of 0.264 and 0.267 (p = 0.00327 and p = 0.00335), respectively. Totally mechanical Collard anastomosis was associated with a lower risk of anastomotic leakage by univariate and multivariate analysis (OR, 0.257, p = 0.00566 and OR, 0.285, p = 0.133, respectively). Three‐year overall survival was 54.2%. Univariate and multivariate analysis of overall survival showed that older age was a risk factor (OR, 1.08) for complications. Conclusion In colon reconstruction after esophageal cancer resection, totally mechanical Collard anastomosis for cervical anastomosis may reduce the risk of Clavien–Dindo grade >III complications.
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Affiliation(s)
- Tomohiro Akutsu
- Division of Esophageal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Takeo Fujita
- Division of Esophageal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Daisuke Kajiyama
- Division of Esophageal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Asako Ozaki
- Division of Esophageal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Kazuma Sato
- Division of Esophageal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Hisashi Fujiwara
- Division of Esophageal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Takashi Kojima
- Division of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Hiroyuki Daiko
- Division of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
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7
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Ileo-right colonic reconstruction preserving all four colonic vessels after esophagectomy for cancer. Updates Surg 2021; 73:2239-2246. [PMID: 33743144 DOI: 10.1007/s13304-021-01033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
When colonic graft is used as an esophageal substitute after esophagectomy, one or two feeding vessels of the colon are cut to obtain sufficient length, the graft is passed via the subcutaneous route, and microvascular anastomosis is often used to avoid fatal complications. Sixteen consecutive ileo-right colonic reconstructions via the posterior mediastinal or retrosternal route with preservation of all four colonic vessels were performed in the past eight years. We presented the surgical technique and evaluation of this surgical method. In 15 out of 16 consecutive cases, the graft could be pulled up to the neck through the posterior mediastinal or retrosternal route while preserving all four colonic vessels. Reconstruction was not possible in one patient because of ileocolic vessel injury during colonic mobilization. Anastomotic leakage occurred in three patients, but all were minor and were treated conservatively. There were no patients with graft necrosis resulting from insufficient blood supply. Ileo-right colonic reconstruction with preservation of all four colonic vessels through the posterior mediastinal or retrosternal route is a safe and feasible procedure and is considered the first choice for colonic reconstruction as an esophageal substitute.
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8
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Marchi F, Kang SC, Cheong DCF, Hung SY, Wang SH, Chiu TH, Chen YT, Tsao CK. The Benefits of the Supercharged Ileocolic Flap in Patients Who Underwent Total Esophagectomy and Gastrectomy. J Reconstr Microsurg 2020; 37:475-485. [PMID: 33202456 DOI: 10.1055/s-0040-1719046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients who undergo total esophagectomy and gastrectomy present a challenging scenario for reconstructive surgeons. Several techniques have been described. However, the best choice is still a matter of debate. We aim to report our experience with the supercharged ileocolic flap, then to compare the long-term functional outcomes in cancer and caustic injury patients. We investigate the safest route of transposition and demonstrate the importance of supercharging the flap. Last, we perform a literature review to compare our results with the ones reported in the literature. METHODS A total of 36 patients underwent the supercharged ileocolic flap procedure. The details reviewed included the type of defect, flap characteristic, route of transposition, complications, patient survival, and swallowing evaluation. Survival and long-term function preservation were considered as the main outcomes. A secondary end-point was the identification of the safest route of transposition. We extracted the pertinent literature on supercharged bowel flaps from 1995 to July 2020 RESULTS: All flaps survived; only two flaps were partially lost. Thirty-three percent of the cohort experienced postoperative complications; the most common was leakage of the cervical anastomosis (17%), followed by neck wound infection (8%). The 5-year dysphagia-free survival rate was 87% in corrosive injury patients and 78% in cancer patients. The mean time to be free from dysphagia after surgery was 25.12 ± 4.55 months for corrosive patients and 39.56 ± 9.45 months for cancer patients (p = 0.118). The safest route of transposition was retrosternal extra-mediastinal. From the literature review, the data from 11 studies were extracted. CONCLUSION The supercharged ileocolic flap is a robust option for total esophageal replacement when the stomach is not available and the retrosternal route is the safest for transposition. The functional outcomes are excellent, with acceptable morbidity and a good life expectancy, either in cancer and noncancer patients. Supercharging the flap is recommended.
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Affiliation(s)
- Filippo Marchi
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan.,Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan.,Department of Otorhinolaryngology, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Shih Ching Kang
- Department of Trauma and Emergency Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
| | - David Chon Fok Cheong
- Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
| | - Shao Yu Hung
- Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
| | - Szu Han Wang
- Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
| | - Ting Han Chiu
- Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
| | - Yu Ting Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
| | - Chung Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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9
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Fernández-Ananín S, Ballester E, Argente CG, Balague C, Targarona EM. Use of endoscopic vacuum (E-Vac) therapy for the treatment of a cervical oesophagoileostomy leakage after a right-colon interposition for oesophageal replacement. Gastroenterol Rep (Oxf) 2020; 8:481-483. [PMID: 33442481 PMCID: PMC7793116 DOI: 10.1093/gastro/goaa036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/29/2020] [Accepted: 06/12/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sonia Fernández-Ananín
- Department of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eulalia Ballester
- Department of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carlos Guarner Argente
- Department of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Gastroenterology and Hepatology Department, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona
| | - Carmen Balague
- Department of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eduard M Targarona
- Department of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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10
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Miyata H, Sugimura K, Shinno N, Hara H, Yamamoto K, Omori T, Haraguchi N, Nishimura J, Yasui M, Yamada D, Wada H, Asukai K, Takahashi H, Ohue M, Yano M. Lymph Node Metastasis and Recurrences from Esophageal Squamous Cell Carcinoma in Patients with Previous Gastrectomy. Ann Surg Oncol 2020; 27:5312-5319. [PMID: 32548753 DOI: 10.1245/s10434-020-08734-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Esophageal cancer patients sometimes have a history of previous gastrectomy. To determine whether we should resect or preserve the remnant stomach, we need to understand the frequency and sites of abdominal lymph node (LN) metastasis from esophageal cancer after gastrectomy. PATIENTS AND METHODS In 46 patients with thoracic esophageal squamous cell carcinoma (ESCC) who had a history of previous gastrectomy due to gastric cancer (n = 20) or benign disease (n = 26), the frequency and sites of any LN metastasis including LN metastasis at surgery and LN recurrence were investigated. The factors associated with abdominal LN metastasis were also examined. RESULTS The incidence of metastasis to cervical, mediastinal, and abdominal LNs at surgery was 10.8%, 30.4%, and 30.4%, respectively. The incidence of abdominal LN recurrence was 6.5%. Of 46 patients, 16 patients (34.8%) had any abdominal LN metastasis, including abdominal LN metastasis at surgery or abdominal LN recurrence. There was no significant difference in the incidence of any abdominal LN metastasis between the gastric cancer group and the benign disease group (25.0% vs. 42.3%, p = 0.222). Clinically, nodal status was identified as the only independent factor associated with the occurrence of any abdominal LN metastasis, although neither tumor location nor the reason for gastrectomy was. CONCLUSIONS The present study showed that the incidence of abdominal LN metastasis from ESCC after gastrectomy was not necessarily low, regardless of the tumor location and the reason for previous gastrectomy. This result suggests that gastrectomy should not be omitted easily in ESCC patients after previous gastrectomy.
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Affiliation(s)
- Hiroshi Miyata
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan.
| | - Keijirou Sugimura
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Naoki Shinno
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hisashi Hara
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuyoshi Yamamoto
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Takeshi Omori
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Naotsugu Haraguchi
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Junichi Nishimura
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masayoshi Yasui
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Daisaku Yamada
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Wada
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kei Asukai
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hidenori Takahashi
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masayuki Ohue
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiko Yano
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
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11
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Zhou P, Wang YL, Liu Q, Li JS. Fallback technique with circular stapler prevents anastomotic obstruction after esophagectomy: A case report of surgical approach. Medicine (Baltimore) 2019; 98:e13571. [PMID: 30813121 PMCID: PMC6408128 DOI: 10.1097/md.0000000000013571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE While performing esophago-ileal anastomosis after esophagectomy with circular staplers, the mucosal folds of the ileum can complicate stapling and lead to obstruction, especially when the diameter of the circular stapler is equal or greater than that of the small bowel lumen. PATIENT CONCERNS A 53-year-old man, presented with complaints of difficulty in swallowing for 2 weeks. Fifteen years previously, he had undergone partial gastrectomy for gastric ulcers. DIAGNOSIS The endoscopy showed that there was a large ulcer in the middle-third of the esophagus, about 28 to 32 cm from the incisors. Biopsy of the ulcer confirmed esophageal squamous cell carcinoma. INTERVENTIONS We performed an esophageal replacement using the right colon with circular staplers, but anastomotic site occurred due to stacking of the mucosa ahead of the stapler. To revise the anastomosis, we inserted the stapler 2 to 3 cm farther into the lumen than the intended site of anastomosis, and then pulled it back and rotated the stapler to complete the anastomosis. Consequently, the obstruction was corrected. OUTCOMES With nearly 16 months' follow-up duration until now, the patient has no difficulty swallowing and has twice received chemotherapy, and returned to his normal life relatively. LESSONS In the event of potential anastomotic obstruction due to accumulated mucosa, the stapler fallback technique can be successfully used achieve patent anastomosis.
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Affiliation(s)
| | - Ya-Li Wang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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12
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Brown J, Lewis WG, Foliaki A, Clark GWB, Blackshaw GRJC, Chan DSY. Colonic Interposition After Adult Oesophagectomy: Systematic Review and Meta-analysis of Conduit Choice and Outcome. J Gastrointest Surg 2018. [PMID: 29520647 DOI: 10.1007/s11605-018-3735-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Colonic interposition is a second-line option after oesophagectomy when a gastric neo-oesophagus is not viable. There is no consensus on the optimum anatomical colonic conduit (right or left), or route of placement (posterior mediastinal, retrosternal or subcutaneous). The aim of this review was to determine the optimum site and route of neo-oesophageal conduit after adult oesophagectomy. METHODS PubMed, MEDLINE, and the Cochrane Library (January 1985 to January 2017) were systematically searched for studies which reported outcomes following colonic interposition in adults. The outcome measures were overall morbidity and mortality. RESULTS Twenty-seven observational studies involving 1849 patients [1177 males; median age (range) 60.5 (18-84) years] undergoing colonic interposition for malignant (n = 697) and benign (n = 1152) pathology were analysed. Overall pooled morbidity of left vs. right colonic conduit was 15.7% [95% CI (11.93-19.46), p < 0.001] and 18.7% [95% CI (15.58-21.82), p < 0.001] respectively. Overall pooled mortality of left vs. right colonic conduit was 6.5% [95% CI (4.55-8.51), p < 0.001] and 10.1% [95% CI (7.35-12.82), p < 0.001] respectively. Retrosternal route placement was associated with the lowest overall pooled morbidity and mortality of 9.2% [95% CI (6.48-11.99), p < 0.001] and 4.8% [95% CI (3.74-5.89), p < 0.001] respectively. CONCLUSION Left colonic conduits placed retrosternally were safest.
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Affiliation(s)
- Jade Brown
- University Hospital of Wales, Heath Park, Cardiff, Wales, CF14 4XN, UK
| | - Wyn G Lewis
- University Hospital of Wales, Heath Park, Cardiff, Wales, CF14 4XN, UK
| | - Antonio Foliaki
- University Hospital of Wales, Heath Park, Cardiff, Wales, CF14 4XN, UK
| | | | | | - David S Y Chan
- University Hospital of Wales, Heath Park, Cardiff, Wales, CF14 4XN, UK.
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13
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Colon Interposition for Esophageal Reconstruction in Cancer Patients. Int Surg 2018. [DOI: 10.9738/intsurg-d-17-00119.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective:
The aim of this study was to report our experience with colon interposition (COI) and to compare the results with an extensive review of the COI literature.
Summary of Background Data:
The stomach is the first choice as an esophageal substitute following esophagectomy in cancer patients, while COI is reserved for patients where the stomach is not available or must be included in the resection due to cancer.
Methods:
We retrospectively reviewed the records of cancer patients undergoing colon interposition from 2006 to 2017. Outcomes were compared with an extensive review of the literature published between 2000 and 2017.
Results:
A total of 13 patients underwent planned COI. Mortality was zero and overall morbidity was 53%; 4 patients suffered from leakage and 2 patients from strictures. None of the patients suffered from necrosis of the interponat and there was no need for subsequent redundancy operations.
The extensive review identified 23 publications. Overall study grading was low (grade C). Only 3 studies were prospective, no randomized studies were found, and many outcomes were poorly defined. The rates for 30-day and in-hospital mortality were 1% and 2%, respectively. Overall morbidity was 43%. The reported number of leakages, strictures, necrosis of the interponat, and redundancy operations varied between 0% and 50%, 0% and 21%, 0% and 9%, and 0% and 2%, respectively.
Conclusions:
COI is a complex technique that is necessary in a relatively small group of selected patients after esophagectomy for cancer. Prospective and comparative studies with strict outcome definitions, long-term follow up, and patient reported outcome measures are lacking.
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Abstract
Esophagectomy and subsequent reconstruction represent major physiological insults to the upper gastrointestinal (GI) tract, which as a consequence can lead to malnutrition, dysphagia and reflux. From a technical perspective, operative reconstruction involving gastric pull-up with a 2-3 cm wide tube and an anastomosis cranial to the azygos vein may minimize the symptoms. Overall, the problems tend to improve approximately 6 months after the operation. Newly occurring delayed physical functional impairments with previously known underlying malignant disease may be indicative of cancer relapse. Interventional techniques, such as stent placement or brachytherapy may be better suited for treatment of recurrent disease.
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Affiliation(s)
- A Beham
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - S Dango
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - B M Ghadimi
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
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15
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Tabola R, Augoff K, Lewandowski A, Ziolkowski P, Szelachowski P, Grabowski K. Esophageal anastomosis - how the granulation phase of wound healing improves the incidence of anastomotic leakage. Oncol Lett 2016; 12:2038-2044. [PMID: 27602135 DOI: 10.3892/ol.2016.4873] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 06/02/2016] [Indexed: 12/22/2022] Open
Abstract
A two-stage esophagectomy with an interval for reconstruction of the esophagus creates an opportunity for the esophageal stump to recover from vessel injury and allows the formation of granulation tissue rich in proangiogenic factors, including transforming growth factor β (TGF-β) and vascular endothelial growth factor A (VEGF-A), which may have an impact on anastomosis healing. The present study comprised 25 patients (27 in total, 2 succumbed to complications following surgery) who underwent two-stage esophagectomy for squamous cell carcinoma in the Department of Gastrointestinal and General Surgery, Wrocław Medical University (Wrocław, Poland) between January 2007 and December 2012. Immunohistochemical staining for VEGF-A and TGF-β was performed to evaluate esophageal wall specimens at the time of esophagostomy construction and prior to anastomosis, in which the cervical esophagus was connected with the colon or ileum. At the time of reconstructive surgery, a significant increase in microvessel density was observed in all esophageal specimens (P<0.03). Significant differences were also identified in the immunohistochemical staining intensity of TGF-β and VEGF-A in the epithelium of all esophageal specimens between biopsies obtained from normal esophageal tissues at the time of esophagectomy and during reconstructive surgery. Delayed anastomosis construction provides an advantage for the esophageal stump to accumulate proangiogenic growth factors, which overlap with the subsequent proliferative stage of the anastomosed tissue and thus supports its recovery, creating an optimal environment for the healing of any fistulas.
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Affiliation(s)
- Renata Tabola
- Department of Gastrointestinal and General Surgery, Wrocław Medical University, 50-369 Wrocław, Poland
| | - Katarzyna Augoff
- Department of Gastrointestinal and General Surgery, Wrocław Medical University, 50-369 Wrocław, Poland
| | - Andrzej Lewandowski
- Department of Gastrointestinal and General Surgery, Wrocław Medical University, 50-369 Wrocław, Poland
| | - Piotr Ziolkowski
- Department of Pathomorphology, Wrocław Medical University, 50-369 Wrocław, Poland
| | - Piotr Szelachowski
- Department of Gastrointestinal and General Surgery, Wrocław Medical University, 50-369 Wrocław, Poland
| | - Krzysztof Grabowski
- Department of Gastrointestinal and General Surgery, Wrocław Medical University, 50-369 Wrocław, Poland
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16
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Watanabe M, Mine S, Nishida K, Kurogochi T, Okamura A, Imamura Y. Reconstruction after esophagectomy for esophageal cancer patients with a history of gastrectomy. Gen Thorac Cardiovasc Surg 2016; 64:457-63. [PMID: 27234222 DOI: 10.1007/s11748-016-0661-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/18/2016] [Indexed: 12/11/2022]
Abstract
Pedicled jejunal flap and colon graft interposition are choices for esophageal reconstruction in patients with a history of gastrectomy or those who have undergone synchronous esophagogastrectomy. However, the optimal conduit in this situation is still being debated. We reviewed the literature concerning esophageal reconstruction using a conduit other than the stomach. Approximately 10 % of esophagectomized patients undergo esophageal reconstruction using pedicled jejunum or colon interposition in Japan. The jejunal graft and colon graft are selected evenly, although the percentage of jejunal graft use is gradually increasing. Microvascular supercharge was performed in most of the reports of pedicled jejunal graft reconstruction, whereas vascular enhancement was not popularly used in the reports of colon graft interposition. Although the incidences of graft loss and anastomotic leakage were comparable between grafts, mortality rates seem to be higher in patients who undergo colon graft reconstruction than in those who undergo reconstruction with a jejunal graft. Prospective comparisons of short-term outcomes as well as long-term quality of life are needed to identify the best method of reconstruction.
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Affiliation(s)
- Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Shinji Mine
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Koujiro Nishida
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takanori Kurogochi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Moore JM, Hooker CM, Molena D, Mungo B, Brock MV, Battafarano RJ, Yang SC. Complex Esophageal Reconstruction Procedures Have Acceptable Outcomes Compared With Routine Esophagectomy. Ann Thorac Surg 2016; 102:215-22. [PMID: 27217296 DOI: 10.1016/j.athoracsur.2016.02.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Complex esophageal reconstruction (CER) is defined as restoring esophageal continuity in a previously operated field, using a nongastric conduit, or after esophageal diversion. This study compares the outcomes of CER with non-CER (NCER), which uses an undisturbed stomach for reconstruction. METHODS This single-institution retrospective cohort study compares 75 CERs with 75 NCERs from 1995 to 2014 that were matched for cancer versus benign disease. Distributions of demographic characteristics, comorbidities, and complications were compared between CER and NCER. Odds of mortality at 30 and 90 days were calculated with logistic regression. Overall survival was illustrated with Kaplan-Meier method and Cox proportional hazards regression. RESULTS Although patients were similar in age, sex, and preoperative comorbidities, more non-white patients underwent CER (p = 0.04). Most NCER patients had adenocarcinoma (44%) or Barrett's high-grade dysplasia (39%); most CER patients had other benign disease (44%) or squamous cell carcinoma (24%, p < 0.01). CER had statistically significantly higher rates of reoperation, pneumonia, infection, and gastrointestinal complications, and longer median length of stay than NCER. Odds of mortality for CER and NCER at 30 days (odds ratio [OR] 1.0, 95% CI: 0.1 to 16.3), 90 days (OR 2.6, 95% CI: 0.5 to 13.9) and overall (adjusted hazard ratio 1.56, 95% CI: 0.9 to 2.7) were not statistically significantly different. CONCLUSIONS Compared with NCER, CER patients had higher rates of return to the operating room, more postoperative infections and gastrointestinal complications, and longer length of stay. However, 30-day, 90-day, and overall survival were similar. CER should be offered to patients with acceptable risks and anticipated long-term survival.
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Affiliation(s)
- Jessica M Moore
- Department of Surgery, Division of Thoracic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Craig M Hooker
- Department of Surgery, Division of Thoracic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Daniela Molena
- Department of Surgery, Division of Thoracic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Benedetto Mungo
- Department of Surgery, Division of Thoracic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Malcolm V Brock
- Department of Surgery, Division of Thoracic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Richard J Battafarano
- Department of Surgery, Division of Thoracic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Stephen C Yang
- Department of Surgery, Division of Thoracic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
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18
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Gust L, Ouattara M, Coosemans W, Nafteux P, Thomas PA, D'Journo XB. European perspective in Thoracic surgery-eso-coloplasty: when and how? J Thorac Dis 2016; 8:S387-98. [PMID: 27195136 DOI: 10.21037/jtd.2016.04.43] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Colon interposition has been used since the beginning of the 20(th) century as a substitute for esophageal replacement. Colon interposition is mainly chosen as a second line treatment when the stomach cannot be used, when the stomach has to be resected for oncological or technical reasons, or when the stomach is deliberately kept intact for benign diseases in young patients with long-life expectancy. During the surgery the vascularization of the colon must be carefully assessed, as well as the type of the graft (right or left colon), the length of the graft, the surgical approach and the route of the reconstruction. Early complications such as graft necrosis or anastomotic leaks, and late complications such as redundancy depend on the quality of the initial surgery. Despite a complex and time-consuming procedure requiring at least three or four digestive anastomoses, reported long term functional outcomes of colon interposition are good, with an acceptable operative risk. Thus, in very selected indications, colon interposition could be seen as a valuable alternative for esophageal replacement when stomach cannot be considered. This review aims at briefly defining "when" and "how" to perform a coloplasty through demonstrative videos.
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Affiliation(s)
- Lucile Gust
- 1 Department of Thoracic Surgery, North Hospital, Aix-Marseille University, Marseille, France ; 2 Department of Thoracic Surgery, University Hospital Campus Gasthuisberg KUZ Leuven, Leuven, Belgium
| | - Moussa Ouattara
- 1 Department of Thoracic Surgery, North Hospital, Aix-Marseille University, Marseille, France ; 2 Department of Thoracic Surgery, University Hospital Campus Gasthuisberg KUZ Leuven, Leuven, Belgium
| | - Willy Coosemans
- 1 Department of Thoracic Surgery, North Hospital, Aix-Marseille University, Marseille, France ; 2 Department of Thoracic Surgery, University Hospital Campus Gasthuisberg KUZ Leuven, Leuven, Belgium
| | - Philippe Nafteux
- 1 Department of Thoracic Surgery, North Hospital, Aix-Marseille University, Marseille, France ; 2 Department of Thoracic Surgery, University Hospital Campus Gasthuisberg KUZ Leuven, Leuven, Belgium
| | - Pascal Alexandre Thomas
- 1 Department of Thoracic Surgery, North Hospital, Aix-Marseille University, Marseille, France ; 2 Department of Thoracic Surgery, University Hospital Campus Gasthuisberg KUZ Leuven, Leuven, Belgium
| | - Xavier Benoit D'Journo
- 1 Department of Thoracic Surgery, North Hospital, Aix-Marseille University, Marseille, France ; 2 Department of Thoracic Surgery, University Hospital Campus Gasthuisberg KUZ Leuven, Leuven, Belgium
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19
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Weiss ARR, Hackl C, Soeder Y, Schlitt HJ, Dahlke MH. Ileo-right hemi-colonic cervical pull-up on a non-supercharged ileocolic arterial pedicle: A technical and case report. World J Gastroenterol 2016; 22:3869-3874. [PMID: 27076773 PMCID: PMC4814751 DOI: 10.3748/wjg.v22.i14.3869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 01/04/2016] [Accepted: 01/30/2016] [Indexed: 02/06/2023] Open
Abstract
Esophageal reconstruction can be challenging when stomach and colon are not anatomically intact and their use as esophageal substitutes is therefore limited. Innovative individual approaches are then necessary to restore the intestinal passage. We describe a technique in which a short stump of the right hemicolon and 25 cm of ileum on a long, non-supercharged, fully mobilized ileocolic arterial pedicle were used for esophageal reconstruction to the neck. In this case, a 65 year-old male patient had accidentally indigested hydrochloric acid which caused necrosis of his upper digestive tract. An emergency esophagectomy, gastrectomy, duodenectomy, pancreatectomy and splenectomy had been performed in an outside hospital. A cervical esophagostomy and a biliodigestive anastomosis had been created and a jejunal catheter for enteral feeding had been placed. After the patient had recovered, a reconstruction of his food passage via the left and transverse colon failed for technical reasons due to an intraoperative necrotic demarcation of the colon. Our team then faced the situation that only a short stump of the right hemi-colon was left in situ when the patient was referred to our center. After intensified nutritional therapy, we reconstructed this patient’s food passage with the right hemicolon-approach described herein. After treatment of a postoperative pneumonia, the patient was discharged from hospital on the 26th postoperative day in a good clinical condition on an oral-only diet. In conclusion, individual approaches for long-segment reconstruction of the esophagus can be technically feasible in experienced hands. They do not always require arterial supercharging or free intestinal transplantation.
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20
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Reslinger V, Tranchart H, D'Annunzio E, Poghosyan T, Quero L, Munoz-Bongrand N, Corte H, Sarfati E, Cattan P, Chirica M. Esophageal reconstruction by colon interposition after esophagectomy for cancer analysis of current indications, operative outcomes, and long-term survival. J Surg Oncol 2015; 113:159-64. [PMID: 26699417 DOI: 10.1002/jso.24118] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/18/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Colon interposition is an alternative solution for esophageal reconstruction if the stomach cannot be used. The study reviews current indications and results of coloplasty for cancer. METHODS Patients who underwent colon interposition for gastro-esophageal malignancy were included. Primary coloplasty was defined as upfront colon interposition. Salvage coloplasty was defined as colon interposition after primary reconstruction failure. Mortality, morbidity, function, and survival were evaluated. RESULTS We included 28 patients (24 men, median age 61 years). Ten (36%) patients underwent primary coloplasty due to previous gastrectomy (n = 5), conduit gastric cancer (n = 2), extensive gastroesophageal involvement (n = 2), and gastric cancer recurrence (n = 1). Salvage coloplasty was performed in 18 (64%) patients for postoperative graft necrosis (n = 5) and intractable strictures (n = 3). Operative mortality, morbidity, and graft necrosis rates were 14% (4/28), 86% (24/28), and 14% (4/28), respectively; there were no significant differences between primary and salvage coloplasty. Survival rates at 1-, 3-, and 5 years were 81%, 51%, and 38%, respectively. Survival was decreased after primary coloplasty when compared to salvage coloplasty (P = 0.03). Nine patients experienced tumor recurrence (primary: n = 6, salvage: n = 3) after coloplasty and eight of them died. CONCLUSION Colon interposition after esophagectomy is a useful but morbid endeavor. Colon interposition as salvage therapy is associated with improved survival compared to its use as primary esophageal replacement, and colon interposition in the latter cohort should be used with caution due to poor cancer-specific survival in this patient population.
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Affiliation(s)
- Vincent Reslinger
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Hadrien Tranchart
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Elsa D'Annunzio
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Tigran Poghosyan
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Laurent Quero
- Department of Radiotherapy, Saint-Louis Hospital, Paris, France
| | - Nicolas Munoz-Bongrand
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Helene Corte
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Emile Sarfati
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Pierre Cattan
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Mircea Chirica
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
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22
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Cancer of the oesophagus and gastroesophageal junction - a difficult clinical problem. Contemp Oncol (Pozn) 2014; 18:349-54. [PMID: 25477759 PMCID: PMC4248053 DOI: 10.5114/wo.2014.43494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/06/2014] [Accepted: 04/11/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cancer located in the oesophagus and gastroesophageal junction is a complex clinical problem and the results of its treatment still remain unsatisfactory. The objective of the study was the clinical analysis of a group of patients with cancer of the oesophagus or gastroesophageal junction, who received combined medical and surgical treatment. MATERIAL AND METHODS The analysis was performed on a group of 128 patients with the diagnosis of oesophageal cancer or cancer of the gastroesophageal junction. Analysis of medical records and follow-up examinations were used in the research procedure. RESULTS From among 128 patients with a diagnosis of oesophageal or gastroesophageal junction cancer, 50 (38.5%) received surgical resections. The surgery most frequently performed (n = 15) was sub-total oesophageal resection according to Akiyama procedure by right-sided thoracotomy (oesophageal anastomosis in the neck). The largest group were patients (n = 26) with stage T3N1M0 of advancement of the disease. In all cases of cancer located in the lower third of the oesophagus, an adenocarcinoma pattern was diagnosed in the histopathological examination, whereas in the case of cancers located in the middle third and upper third of the thoracic oesophagus a carcinoma planoepitheliale pattern was seen. Anastomotic leaks occurred in seven patients (14%). Six patients died during the post-operative period (12%). The mean survival time in the group of analysed patients was two years. CONCLUSIONS Cancer of the oesophagus or gastroesophageal junction is associated with low resectability, high risk of complications after surgery, and poor oncologic outcome. It is necessary to seek new methods of treatment.
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Kumar NAN, Ramalingam R, Kumar HH, Ramkumar A, Vijayahari R. Ileocolon Interposition Graft Following Surgery for Gastro-esophageal Junction Adenocarcinoma. Indian J Surg Oncol 2014; 4:151-4. [PMID: 24426718 DOI: 10.1007/s13193-013-0227-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 02/05/2013] [Indexed: 11/25/2022] Open
Affiliation(s)
- Naveena A N Kumar
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, IIIrd Floor SS Block, Puducherry, 605006 India
| | - Rajeshwaran Ramalingam
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, IIIrd Floor SS Block, Puducherry, 605006 India
| | - Harish H Kumar
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, IIIrd Floor SS Block, Puducherry, 605006 India
| | - Aravind Ramkumar
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, IIIrd Floor SS Block, Puducherry, 605006 India
| | - Ranjit Vijayahari
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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24
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A cure with successful staged treatment of aortoesophageal fistula. Gen Thorac Cardiovasc Surg 2013; 64:28-30. [DOI: 10.1007/s11748-013-0351-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 11/20/2013] [Indexed: 10/26/2022]
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25
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Markar SR, Arya S, Karthikesalingam A, Hanna GB. Technical factors that affect anastomotic integrity following esophagectomy: systematic review and meta-analysis. Ann Surg Oncol 2013; 20:4274-81. [PMID: 23943033 DOI: 10.1245/s10434-013-3189-x] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Due to the significant contribution of anastomotic leak, with its disastrous consequences to patient morbidity and mortality, multiple parameters have been proposed and individually meta-analyzed for the formation of the ideal esophagogastric anastomosis following cancer resection. The purpose of this pooled analysis was to examine the main technical parameters that impact on anastomotic integrity. METHODS Medline, Embase, trial registries, and conference proceedings were searched. Technical factors evaluated included hand-sewn versus stapled esophagogastric anastomosis (EGA), cervical versus thoracic EGA, minimally invasive versus open esophagectomy, anterior versus posterior route of reconstruction and ischemic conditioning of the gastric conduit. The outcome of interest was the incidence of anastomotic leak, for which pooled odds ratios were calculated for each technical factor. RESULTS No significant difference in the incidence of anastomotic leak was demonstrated for the following technical factors: hand-sewn versus stapled EGA, minimally invasive versus open esophagectomy, anterior versus posterior route of reconstruction and ischemic conditioning of the gastric conduit. Four randomized, controlled trials comprising 298 patients were included that compared cervical and thoracic EGA. Anastomotic leak was seen more commonly in the cervical group (13.64 %) than in the thoracic group (2.96 %). Pooled analysis demonstrated a significantly increased incidence of anastomotic leak in the cervical group (pooled odds ratio = 4.73; 95 % CI 1.61-13.9; P = 0.005). CONCLUSIONS A tailored surgical approach to the patient's physiology and esophageal cancer stage is the most important factor that influences anastomotic integrity after esophagectomy.
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Affiliation(s)
- Sheraz R Markar
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK,
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