Esophageal Bypass Surgery (Postlethwait Method): Postoperative Course and Outcomes

Background In cases of advanced esophageal cancer and esophageal stenosis following chemoradiotherapy (CRT), oral intake often becomes difficult, significantly reducing patients’ quality of life (QOL). Esophageal bypass surgery is one option to maintain oral intake. To continue chemotherapy, maintaining oral intake and controlling airway complications are crucial. Methods A retrospective analysis was conducted on cases that underwent esophageal bypass surgery (Postlethwait method) at Kobe University and its affiliated hospitals between January 2021 and December 2022. Results The cohort included two male and three female patients. The indications for surgery were passage obstruction after CRT in three cases, stenosis after endoscopic submucosal dissection (ESD) in one case, and mediastinal perforation in one case. Among the five cases, three experienced airway obstruction due to tracheoesophageal fistula or bronchial invasion during the continuation of chemotherapy postoperatively. The remaining two cases did not receive postoperative treatment and ultimately succumbed to other diseases. The mean survival time from the Postlethwait procedure was 528 (285–973) days. Patients were able to maintain a relatively stable QOL, with adequate oral intake until death. Conclusion Esophageal bypass surgery (Postlethwait method) contributes to maintaining patients’ QOL. Even in cases of unresectable esophageal cancer, if oral intake is preserved and airway complications are managed, continued chemotherapy is feasible, potentially leading to a relatively prolonged prognosis.