G. Takiguchi1, T. Nakamura1, H. Hasegawa1, M. Yamamoto1, Y. Matsuda1, S. Kanaji1, K. Yamashita1, T. Oshikiri1, T. Matsuda1, S. Suzuki1, Y. Kakeji1 1Kobe University Graduate School of Medicine,Gastrointestinal Surgery,Kobe, HYOGO, Japan
Introduction: The safe and secure esophageal reconstruction method in patients whose stomach is unavailable is still unsettled issue. Recently, the number of cases using pedicled jejunum flap (PJF) as an alternative conduit are increasing when the stomach is unavailable. The objective of this study is to elucidate advantages of reconstruction by PJF.
Methods: Forty-nine patients whose stomach was unavailable for the conduit following esophagectomy were enrolled in this study: 10 patients underwent ileo-colon (IC) reconstruction after esophagectomy from January 2005 to January 2011; after that 39 patients underwent esophageal reconstruction by PJF with microvascular augmentation from February 2011 to January 2018. Surgical outcomes, complications, perioperative serous albumin levels and postoperative body mass index (BMI) changes were retrospectively reviewed and compared between IC and PJF group.
Results:Anastomotic leakage rate was significantly lower in PJF group than those of IC group (10.3 % vs. 50.0 %, P=0.011). There was no severe diarrhea in PJF group while 30.0 % was observed in IC group. The mean serum albumin level was higher all through the postoperative period in PJF group than IC group. Especially, PJF group showed significant better recovery of serum albumin level compared to IC group at two weeks after operation (2.70 g/dl vs 2.20 g/dl, P=0.003). The mean decrease rate of postoperative BMI was lower in the PJF group than in the IC group. In the IC group, one patient died due to the postoperative pneumonia and brain infarction, but there was no mortality in the PJF group.
Conclusion:The reconstruction by PJF with microvascular augmentation following esophagectomy was superior to reconstruction by IC at the point of anastomotic leakage and severe diarrhea. Also, PJF has an advantage in earlier recovery of postoperative serum albumin level and keeping the body weight than IC. PJF might be a better choice for reconstruction after esophagectomy than IC in patients whose stomach is unavailable.