Esmonde N, Rodan W, Haisley K R, Joslyn N, Carboy J, Hunter J G, Schipper P H, Tieu B H, Hansen J, Dolan J P
Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
School of Medicine, Oregon Health and Science University, Portland, OR, USA.
Dis Esophagus. 2020 Oct 12;33(10). doi: 10.1093/dote/doaa008.
Locoregional esophageal cancer is currently treated with induction chemoradiotherapy, followed by esophagectomy with reconstruction, using a gastric conduit. In cases of conduit failure, patients are temporized with a cervical esophagostomy and enteral nutrition until gastrointestinal continuity can be established. At our institution, we favor reconstruction, using a colon interposition with a 'supercharged' accessory vascular pedicle. Consequently, we sought to examine our technique and outcomes for esophageal reconstruction, using this approach. We performed a retrospective review of all patients who underwent esophagectomy at our center between 2008 and 2018. We identified those patients who had a failed gastric conduit and underwent secondary reconstruction. Patient demographics, perioperative details, and clinical outcomes were analyzed after our clinical care pathway was used to manage and prepare patients for a second major reconstructive surgery. Three hundred and eighty eight patients underwent esophagectomy and reconstruction with a gastric conduit. Seven patients (1.8%) suffered gastric conduit loss and underwent a secondary reconstruction using a colon interposition with a 'supercharged' vascular pedicle. Mean age was 70.1 (±7.3) years, and six patients were male. The transverse colon was used in four cases (57.1%), left colon in two cases (28.6%), and right colon in one case (14.3%). There were no deaths or loss of the colon interposition at follow-up. Three patients (42.9%) developed an anastomotic leak, which resolved with conservative management. All patients had resumption of oral intake within 30 days. Utilizing a 'supercharging' technique for colon interposition may improve the perfusion to the organ and may decrease morbidity. Secondary reconstruction should occur when the patient's oncologic, physiologic, and psychosocial condition is optimized. Our outcomes and preoperative strategies may provide guidance for those centers treating this complicated patient population.
局部区域性食管癌目前采用诱导放化疗，随后使用胃管道进行食管切除术并重建。在管道失败的情况下，患者通过颈段食管造口术和肠内营养维持，直到能够重建胃肠道连续性。在我们机构，我们倾向于使用带有“增压”附属血管蒂的结肠间置术进行重建。因此，我们试图研究使用这种方法进行食管重建的技术和结果。我们对2008年至2018年期间在我们中心接受食管切除术的所有患者进行了回顾性研究。我们确定了那些胃管道失败并接受二次重建的患者。在我们使用临床护理路径对患者进行管理并为第二次重大重建手术做准备后，分析了患者的人口统计学特征、围手术期细节和临床结果。388例患者接受了胃管道食管切除术和重建术。7例患者（1.8%）胃管道失败，接受了使用带有“增压”血管蒂的结肠间置术的二次重建。平均年龄为70.1（±7.3）岁，6例为男性。4例（57.1%）使用横结肠，2例（28.6%）使用左结肠，1例（14.3%）使用右结肠。随访期间无死亡病例，结肠间置术也未失败。3例患者（42.9%）发生吻合口漏，经保守治疗后痊愈。所有患者均在30天内恢复经口进食。采用“增压”技术进行结肠间置术可能会改善器官灌注并降低发病率。当患者的肿瘤、生理和心理社会状况达到最佳时，应进行二次重建。我们的结果和术前策略可为治疗这类复杂患者群体的中心提供指导。
