Management of Complex Postoperative Complications in a Patient With Cervical Esophageal Cancer Treated With Jejunal Interposition Graft: A Case Report

Background Cervical esophageal cancer, which accounts for 5–10% of esophageal malignancies, poses great challenges in treatment due to its intricate anatomy and high—risk of complications. Here, a 76—year—old male patient with squamous cell carcinoma had recurrent stenosis after chemoradiotherapy, thus requiring jejunal interposition transplantation. Elderly patients with a history of radiotherapy face elevated risks of postoperative complications, making elaborate surgical planning and multidisciplinary management necessary. Methods The patient underwent cervical esophagectomy with total laryngectomy and jejunal interposition transplantation. After being anesthetized via tracheal intubation and having the surgical field disinfected, incisions were made. A U—shaped incision in the neck was used to expose and dissect relevant muscles and tissues, and the larynx and cervical esophagus were resected. In the abdomen, a 10—cm incision was made to locate and harvest a 15—cm jejunal segment with intact blood vessels. The jejunum was perfused and transplanted to the neck. Microvascular anastomosis was meticulously conducted to restore blood supply. Intraoperative frozen biopsy confirmed tumor—free margins. Results Postoperatively, the patient developed complications such as intestinal obstruction, pharyngocutaneous fistula, venous thrombosis, hypoalbuminemia, and anemia. Through multidisciplinary treatment, including surgical intervention for intestinal obstruction, conservative management for pharyngocutaneous fistula, anticoagulation and physical prophylaxis for venous thrombosis, and albumin and red blood cell transfusions for hypoalbuminemia and anemia, the patient’s condition stabilized, and the patient was discharged on October 5, 2024. Conclusion This case emphasizes the significance of surgical precision and multidisciplinary cooperation in treating elderly patients with complex reconstructive surgery. The jejunal interposition transplantation shows great potential in esophageal cancer treatment. With the development of surgical techniques and peri—operative management, it can better restore esophageal function. It offers a new option for patients who are not suitable for traditional esophageal resection methods. However, challenges like preventing complications still exist. Further research and improvement in surgical procedures and postoperative care are needed to fully explore its prospects and benefit more patients.