Jejunal and colonic reconstruction after esophagectomy in difficult gastric conduit: a multicenter study and meta-analysis.

PURPOSE

When using the stomach for esophageal reconstruction is not viable, the jejunum or colon is used, but the optimal choice of organ remains unclear.

METHODS

We conducted this multicenter retrospective cohort study to compare the short-term outcomes of patients who underwent jejunal or colonic reconstruction across four centers between January 2011 and March 2023. We also conducted a meta-analysis of studies published before November 2024 using the Mantel-Haenszel random-effects model to compare cervical anastomosis outcomes between jejunal and colonic reconstruction after esophageal cancer surgery.

RESULTS

Vascular anastomosis was more frequent in the jejunal group (n = 16; p = 0.001), whereas simultaneous gastrectomy was more common in the colonic group (n = 13; p = 0.029). No significant differences were observed in anastomotic leakage (31.3 vs. 46.2%, p = 0.466), graft necrosis (6.3 vs. 0.0%, p = 1), or hospital mortality (6.3 vs. 7.7%, p = 1) between the groups. The meta-analysis showed a trend toward reduced leakage for jejunal reconstruction with vascular anastomosis (OR = 0.42, 95% CI = 0.16-1.01, p = 0.05). Other outcomes were similar.

CONCLUSIONS

The short-term outcomes of jejunal and colonic reconstructions were comparable. Jejunal reconstruction with vascular anastomosis may reduce leakage, but its prognostic benefits remain unclear.

TRIAL REGISTRATION

no. M-2023-102.