Abstract
Abstract Background Elderly patients or those who have undergone surgery for head and neck cancer (HNC) have a potential risk of dysphagia, in addition, the latter has a considerable difficulty for surgery for the neck. Intrathoracic anastomosis is preferable to preserve swallowing function and reduce surgical risk, because the cervical procedure can be avoided. However, the stomach cannot be used as a substitute in gastrectomized patients; thus, securing graft blood supply is critical. Nevertheless, microvascular anastomosis cannot easily be added in procedures for intrathoracic posterior mediastinal reconstruction. We therefore designed a novel technique for esophageal reconstruction to enable both intrathoracic anastomosis and microvascular anastomosis simultaneously even in gastrectomized patients. The purpose of this study was to evaluate the usefulness and safety of this technique. Methods Esophagectomy with mediastinal lymphadenectomy is performed through a right thoracotomy in the left decubitus position, and temporary chest closure is done after the esophagus is divided at the upper mediastinum with safe margin. Next, the patient is placed in the left half side-lying position, and the jejunal or ileocolic graft for reconstruction is created after removal of the remnant stomach in the supine position. Then, after the patient's position is changed to the left decubitus one and rethoracotomy is performed, the graft is pulled up through the anterior mediastinum, and is then passed into the right thoracic cavity via a small hole made in the anterior mediastinal pleura. The graft is then finally anastomosed with the remnant esophagus in the upper posterior mediastinum. Thereafter, microvascular anastomosis is performed in the retrosternal space through the skin incision in the supine position. Finally, the continuity of alimentary tract is completed. Results This new reconstruction procedure was performed for 4 patients with no significant postoperative complications, good swallowing function postoperatively, and no retention of food in the graft. There was no in-hospital death. Conclusion This novel trans-mediastinal reconstruction technique is a possible option in terms of enabling intrathoracic anastomosis and addition of microvascular anastomosis for highly selected gastrectomized patients with advanced age or a past history of HNC surgery. Disclosure All authors have declared no conflicts of interest.
Published Version
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