Comparison of outcomes of pedicled jejunal and colonic conduit for esophageal reconstruction

Sicong Jiang, Changying Guo, Bin Zou, Jianguo Xie, Zhihui Xiong, Yukang Kuang, Jianjun Tang, Sicong Jiang, Changying Guo, Bin Zou, Jianguo Xie, Zhihui Xiong, Yukang Kuang, Jianjun Tang

Abstract

Background: At present, the gastric tube is the first choice for esophageal reconstruction after esophagectomy for various benign and malignant diseases. However, when the stomach is not available, a pedicled jejunum or colon is used to reconstruct the esophagus. The present study aimed to compare the postoperative outcomes and quality of life of patients receiving jejunal and colonic conduits.

Methods: In the present retrospective study, the clinical data of 71 patients with esophageal carcinoma, who received jejunal reconstruction (jejunum group, n = 34) and colonic reconstruction (colon group, n = 37) from 2005 to 2015, were compared.

Results: Compared with the colon group, the jejunum group had a lower incidence of postoperative anastomotic leakage, lesser duration of postoperative drainage, and faster recovery. Furthermore, the scores were better in the jejunum group than in the colon group, in terms of short-term overall quality of life, physical function and social relationships. Moreover, the jejunal group had a significantly lower frequency of pH < 4 simultaneous reflux time > 5 min (N45) and the longest reflux time (LT) at 24 weeks after surgery.

Conclusion: In esophageal cancer, when gastric tube construction is not feasible, a pedicled jejunum may be preferred over a colonic conduit due to lower incidence of acid reflux, anastomotic leakage and higher postoperative short-term quality of life, and rapid postoperative recovery.

Keywords: Esophageal cancer; Gastric remnant; Pedicle jejunum; Postoperative; Reconstruction.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart showing the various surgical approaches, conduits and types of gastrointestinal reconstruction performed for the study patients
Fig. 2
Fig. 2
Postoperative acid reflux in patients with jejunal and colonic conduits measured using a pH meter. The jejunal group had significantly lower numbers of pH  5 min (N45) (a) and the longest reflux time (LT) (b) at 24 weeks, when compared to the colon group
Fig. 3
Fig. 3
Comparison of postoperative quality of life (QLQ-C30) questionnaire scores in patients who received jejunal and colonic conduits: (a) overall quality of life, (b) physical functions, (c) social relationships, and (d) pain scores. The error bars represent the standard deviation
Fig. 4
Fig. 4
Comparison of postoperative quality of life (QLQ-OES18) supplemental scale scores in patients who received jejunal and colonic conduits: (a) fatigue score, (b) dyspnea score, (c) loss of appetite score, and (d) gastroesophageal reflux score

References

    1. Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66:115–132.
    1. Kwon JS, Kim JB, Cho KB, Kim ES, Park KS, Park CK. Gastric tube reconstruction of esophagus for esophageal and stomach carcinomas. Asian Cardiovasc Thorac Ann. 2012;20:600–603. doi: 10.1177/0218492312440804.
    1. Fujiwara Y, Nakagawa K, Kusunoki M, Tanaka T, Yamamura T, Utsunomiya J. Gastroesophageal reflux after distal gastrectomy: possible significance of the angle of his. Am J Gastroenterol. 1998;93:11–15. doi: 10.1111/j.1572-0241.1998.011_c.x.
    1. Lee SS, Chung HY, Kwon OK, Yu W. Long-term quality of life after distal subtotal and Total Gastrectomy: symptom- and behavior-oriented consequences. Ann Surg. 2016;263:738–744. doi: 10.1097/SLA.0000000000001481.
    1. 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;64:457–463. doi: 10.1007/s11748-016-0661-0.
    1. Kelling GE. Oesophagoplastic mit hilt des Quarkolon. Semin Med. 1911;38:1209–1212.
    1. Irino T, Tsekrekos A, Coppola A, Scandavini CM, Shetye A, Lundell L, et al. Long-term functional outcomes after replacement of the esophagus with gastric, colonic, or jejunal conduits: a systematic literature review. Dis Esophagus. 2017;30:1–11. doi: 10.1093/dote/dox083.
    1. Kun L, Herbella FA, Dubecz A. 1913: Annus mirabilis of esophageal surgery. Thorac Cardiovasc Surg. 2013;61:460–463. doi: 10.1055/s-0032-1322620.
    1. Longmire WP, Ravitch MM. A new method for constructing an artificial esophagus. Ann Surg. 1946;123:819–834. doi: 10.1097/00000658-194605000-00008.
    1. Gaur P, Blackmon SH. Jejunal graft conduits after esophagectomy. J Thorac Dis. 2014;6(Suppl 3):S333–S340.
    1. Blackmon SH, Correa AM, Skoracki R, Chevray PM, Kim MP, Mehran RJ, et al. Supercharged pedicled jejunal interposition for esophageal replacement: a 10-year experience. Ann Thorac Surg. 2012;94:1104–1111. doi: 10.1016/j.athoracsur.2012.05.123.
    1. Li M, Hu ZD, Yu MF, Feng CW, Yuan FL, Zhang Q, et al. Surgical treatment of 33 cases of esophageal cancer after partial gastric resection. Chin J Thorac Cardiovasc Surg. 2011;27:312.
    1. Jun W, Wei W, Weibing W, Jing X, Fuxi Z, Xiaoxiang X, et al. Clinical outcome of using gastric remnant or jejunum or colon conduit in surgery for esophageal carcinoma with previous gastrectomy. J Surg Oncol. 2017;115:729–737. doi: 10.1002/jso.24564.
    1. Marks JL, Hofstetter WL. Esophageal reconstruction with alternative conduits. Surg Clin North Am. 2012;92:1287–1297. doi: 10.1016/j.suc.2012.07.006.
    1. Ninomiya I, Okamoto K, Oyama K, Hayashi H, Miyashita T, Tajima H, et al. Feasibility of esophageal reconstruction using a pedicled jejunum with intrathoracic esophagojejunostomy in the upper mediastinum for esophageal cancer. Gen Thorac Cardiovasc Surg. 2014;62:627–634. doi: 10.1007/s11748-014-0435-5.
    1. Doki Y, Ishikawa O, Takachi K, Miyashiro I, Sasaki Y, Ohigashi H, et al. Association of the primary tumor location with the site of tumor recurrence after curative resection of thoracic esophageal carcinoma. World J Surg. 2005;29:700–707. doi: 10.1007/s00268-005-7596-4.
    1. Groenvold M, Klee MC, Sprangers MA, Aaronson NK. Validation of the EORTC QLQ-C30 quality of life questionnaire through combined qualitative and quantitative assessment of patient-observer agreement. J Clin Epidemiol. 1997;50:441–450. doi: 10.1016/S0895-4356(96)00428-3.
    1. Baker CR, Forshaw MJ, Gossage JA, Ng R, Mason RC. Long-term outcome and quality of life after supercharged jejunal interposition for oesophageal replacement. Surgeon. 2015;13:187–193. doi: 10.1016/j.surge.2014.01.004.
    1. Viklund P, Lindblad M, Lagergren J. Influence of surgery-related factors on quality of life after esophageal or cardia cancer resection. World J Surg. 2005;29:841–848. doi: 10.1007/s00268-005-7887-9.
    1. Blazeby JM, Conroy T, Hammerlid E, Fayers P, Sezer O, Koller M, et al. Clinical and psychometric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer. Eur J Cancer. 2003;39:1384–1394. doi: 10.1016/S0959-8049(03)00270-3.
    1. Wise J. Obesity, smoking, and acid reflux are behind doubling in incidence of oesophageal cancer. Bmj. 2013;346:f3959. doi: 10.1136/bmj.f3959.
    1. Pera M, Trastek VF, Carpenter HA, Fernandez PL, Cardesa A, Mohr U, et al. Influence of pancreatic and biliary reflux on the development of esophageal carcinoma. Ann Thorac Surg. 1993;55:1386–1392. doi: 10.1016/0003-4975(93)91077-Z.
    1. Haubrich WS, Schaffner F, Berk JE. Bockus Gastroenterology. 5. Philadelphia, PA: W.B: Saunders Company; 1995.
    1. Doki Y, Okada K, Miyata H, Yamasaki M, Fujiwara Y, Takiguchi S, et al. Long-term and short-term evaluation of esophageal reconstruction using the colon or the jejunum in esophageal cancer patients after gastrectomy. Dis Esophagus. 2008;21:132–138. doi: 10.1111/j.1442-2050.2007.00738.x.
    1. Peng X, Zhong QS, Ji RM, Wang XL, Meng RG. Applied anatomy of the large intestine. Chin J Clin Anat. 2000;18:51–52.
    1. Kim D, Min YW, Park JG, Lee H, Min BH, Lee JH, et al. Influence of esophagectomy on the gastroesophageal reflux in patients with esophageal cancer. Dis Esophagus. 2017;30:1–7. doi: 10.1093/dote/dox106.
    1. Oh HJ, Choi MG, Park JM, Song KY, Yoo HM. Acid secretion and its relationship to esophageal reflux symptom in patients with subtotal gastrectomy. Dig Dis Sci. 2018;63:703–12.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi