RA05.07: ESOPHAGEAL RECONSTRUCTION BY PEDICLED TERMINAL ILEUM AND RIGHT COLON WITH PRESERVED ILEOCOLIC VESSELS

Abstract

Abstract Background In the case of esophageal cancer patient whose stomach is not available for reconstruction, we had been using pedicled jejunum for lower esphageal cancer or right colon reconstruction as an alternative. However, high incidence of postoperative anastomotic leakage regarding insufficient blood supply was a great distress. We started the unique reconstruction technique using terminal ileum and right colon with preserved ileocolic vessels in 2011. Based on our experience, we considered benefits of our method. Methods After esophagectomy and lymphadenectomy, the ascending colon was mobilized. The mid colic, right colic (if exist) and ileocolic vessels, as well as marginal vessels of terminal ileum, were preserved, the ileum was cut at the point approximately 20–30cm from the ileum end. The final ileal artery and vein may be ligated and cut, if necessary. The pedicled ileo-colon was, then, carefully lifted isoperistaltically via subcutaneous route. Esophagoileostomy was usually performed by functional end to end anastomosis. Additional anastomoses were performed by Billroth II or Roux en Y method. Results In total of 383 patients who were underwent transthoracic esophagectomy between 1998 and 2017, 15 pedicled jejunum (J), 4 traditional right colon (C) and 6 ileo-colon preserved ileocolic vessels (IC) were used for reconstruction. The incidence of esophagoileostomy-related complications were 6.7% (1/15) in J, 50.0% (2/4) in C and 33.3% (2/6) in IC. One in IC showed ileal necrosis caused by sclerotic obstruction on the root of ICA, then remained right colon was used for free flap salvage reconstruction. Two in C suffered from pneumonia at early post-operative days, probably because of microaspiration of colic bacterium, interestingly, there was no caces of pneumonia in IC. In addition, the subcutaneous space was occupied only with the ileum, therefore the antesternal skin bloating was not bulky. Conclusion The advantages of our technique are; i) less anastomotic complications, ii)possibility of less aspiration pneumonia, iii) better cosmetic appearance, and iv) no microvascular surgery required. Our technique could be used as the standard method of reconstruction after esophagectomy for patients in whom stomach is not available. Disclosure All authors have declared no conflicts of interest.