Zhao Lilan, Ding Yun, Zhang Juan, Tu Pengjie, He Zijie, Li Genglin, Lin Zhaoxian, Lin Xing, Lin Zhiwei, Zhang Zhenlong, Guo Tianxing, Zhu Lihuan, Chen Wenshu, Ou Debin, Pan Xiaojie
Department of Thoracic Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350001, China.
Clinical School of Thoracic, Tianjin Medical University, Tianjin, 300222, China.
BMC Surg. 2025 Jul 19;25(1):302. doi: 10.1186/s12893-025-03006-4.
The standard esophageal replacement for esophageal cancer treatment is a gastric conduit. However, jejunal interposition is often utilized when the stomach is not available. The purpose of this study was to review our experience with this technique, particularly in cases not requiring microvascular anastomosis, and assess surgical outcomes.
We retrospectively reviewed the medical records of cancer patients who underwent jejunum interposition at our institution from 2003 to 2020. Data regarding patient characteristics, operative technique, and postoperative outcomes were collected and analyzed. Factors affecting oncologic outcomes were evaluated using Kaplan-Meier estimates and Cox regression. Postoperative conduit function was assessed at 6 months.
With a median follow-up of 35 months, 122 patients (113 males and 9 females; aged 40 to 86 years) were included. Over half (54.9%, 67/122) had stage III or higher disease. Median operation time was 270 min, and the median drainage time was 8 days. Postoperative complications occurred in 28.7% of patients, with pulmonary infections being the most common. The anastomotic leakage rate was 4.1% (5/122), and the 90-day mortality rate was 5.7%. The overall survival rates at 1, 3, and 5 years were 79.5%, 49.0%, and 35.6%, respectively. The prognosis was mainly correlated with tumor stage and most patients reported good quality of life.
Our findings suggests that, even without vascular anastomosis, jejunal conduit is a feasible procedure for reconstruction after esophagectomy, resulting in low morbidity and favorable prognosis.
食管癌治疗的标准食管替代物是胃管道。然而，当无法使用胃时，空肠间置术经常被采用。本研究的目的是回顾我们使用该技术的经验，特别是在不需要微血管吻合的病例中，并评估手术结果。
我们回顾性分析了2003年至2020年在我院接受空肠间置术的癌症患者的病历。收集并分析了患者特征、手术技术和术后结果的数据。使用Kaplan-Meier估计和Cox回归评估影响肿瘤学结果的因素。术后6个月评估管道功能。
中位随访35个月，纳入122例患者（男性113例，女性9例；年龄40至86岁）。超过一半（54.9%，67/122）患有III期或更高分期的疾病。中位手术时间为270分钟，中位引流时间为8天。28.7%的患者发生术后并发症，其中肺部感染最为常见。吻合口漏率为4.1%（5/122），90天死亡率为5.7%。1年、3年和5年的总生存率分别为79.5%、49.0%和35.6%。预后主要与肿瘤分期相关，大多数患者报告生活质量良好。
我们的研究结果表明，即使不进行血管吻合，空肠管道也是食管癌切除术后重建的可行手术，发病率低且预后良好。
