Favorable outcomes with jejunal interposition without vascular anastomosis for esophagectomy in cancer patients: a single-center experience

BACKGROUND: The standard esophageal replacement for esophageal cancer treatment is a gastric conduit. However, jejunal interposition is often utilized when the stomach is not available. The purpose of this study was to review our experience with this technique, particularly in cases not requiring microvascular anastomosis, and assess surgical outcomes. METHODS: We retrospectively reviewed the medical records of cancer patients who underwent jejunum interposition at our institution from 2003 to 2020. Data regarding patient characteristics, operative technique, and postoperative outcomes were collected and analyzed. Factors affecting oncologic outcomes were evaluated using Kaplan-Meier estimates and Cox regression. Postoperative conduit function was assessed at 6 months. RESULTS: With a median follow-up of 35 months, 122 patients (113 males and 9 females; aged 40 to 86 years) were included. Over half (54.9%, 67/122) had stage III or higher disease. Median operation time was 270 min, and the median drainage time was 8 days. Postoperative complications occurred in 28.7% of patients, with pulmonary infections being the most common. The anastomotic leakage rate was 4.1% (5/122), and the 90-day mortality rate was 5.7%. The overall survival rates at 1, 3, and 5 years were 79.5%, 49.0%, and 35.6%, respectively. The prognosis was mainly correlated with tumor stage and most patients reported good quality of life. CONCLUSION: Our findings suggests that, even without vascular anastomosis, jejunal conduit is a feasible procedure for reconstruction after esophagectomy, resulting in low morbidity and favorable prognosis.