Supradiaphragmatic Roux-en-Y Reconstruction After Extended Total Gastrectomy for Esophagogastric Adenocarcinoma at a Single Institution

Abstract Background The optimal surgical approach for patients with esophagogastric adenocarcinoma is debated, with options including esophagectomy and total gastrectomy. However, any patient with significant tumor extension into the esophagus and stomach, or tumor extension into the esophagus without a suitable stomach for a conduit, may require an extended total gastrectomy (i.e., resection of the distal esophagus and the stomach). Roux-en-Y jejunal conduits are commonly used for reconstruction; however, concerns exist regarding the ability to obtain adequate length for a supradiaphragmatic anastomosis. We present a case series of patients who underwent total extended gastrectomy with a long intrathoracic Roux-en-Y reconstruction. Methods This retrospective study analyzed patients with esophagogastric adenocarcinoma who underwent extended total gastrectomy at our institution between 2016 and 2023. We examined clinicopathologic characteristics descriptively and assessed quality of life using a Likert scale survey. To achieve sufficient conduit length, the Roux-en-Y jejunal conduit was constructed by dividing the second, and occasionally the third, jejunal arterial branches (Fig. 1). Disease-free survival was defined as the time from surgery to recurrence or death from any cause. Results Overall, 29 patients met the inclusion criteria. Median age was 64 years. Overall, 83% received neoadjuvant therapy. Five patients (17%) experienced an anastomotic leak, and 9 (31%) had grade 3–4 complications. The median DFS was 4.5 years, and 72% of patients resumed a regular diet within 3 months. Compared to patients who underwent standard esophagectomy, those who had gastrectomy had a longer hospital stay (11 vs. 9 days; p = 0.048), but similar complication rates. With the exception of diarrhea at 2 weeks (worse for gastrectomy patients mean score, 2.8 vs. 1.4; p = 0.001) quality of life was not statistically different between groups. Conclusion Supradiaphragmatic Roux-en-Y jejunal reconstruction after extended total gastrectomy for gastroesophageal junction adenocarcinoma is a feasible approach and with low complication rates and adequate recovery of quality of life.