Comparison of Treatment Outcomes Between Jejunal and Colonic Reconstruction After Subtotal Esophagectomy

Background When a gastric conduit is unavailable after subtotal esophagectomy, a pedicled jejunal flap or an ileocolonic interposition reconstruction is generally used. The pedicled jejunal flap has lower surgical invasiveness due to fewer anastomoses and less mobilization than the ileocolonic interposition, whereas it frequently requires vascular anastomosis for adequate blood supply. Although the choice of reconstruction depends on the surgeon’s preference, the optimal conduit is still debated. The aim of study was to compare the surgical outcomes and postoperative nutritional status of the pedicled jejunal flap and the ileocolonic interposition reconstruction. Methods The clinical data of consecutive patients who underwent subtotal esophagectomy with non-gastric reconstruction between March 2013 and April 2023 were retrospectively reviewed. Statistical analysis was performed using EZR (version 1.54; Saitama Medical Center, Jichi Medical University, Saitama, Japan). Results Thirty-one patients reconstructed with the pedicled jejunal flap (JF group) and 15 patients reconstructed with ileocolonic interposition (II group) were included. A subcutaneous route was significantly more performed in the JF group than II group (64.5% vs 13.3%, p = 0.005). Postoperative hospital stay was significantly shorter in the JF group than II group (22 days vs 47 days, p = 0.003). There was no significant difference in anastomotic leakage (12.9% vs 40.0%, p = 0.057) and in the rate of body-weight loss 1 year after surgery between the JF and the II groups (9.3% vs 14.4%, p = 0.151), respectively. Conclusion The pedicled jejunal flap may be considered the first choice of reconstruction for patients whose gastric conduit is not available in terms of shorter hospital stay; however, further studies are needed to establish the optimal reconstruction for them.