Simultaneous Vascular Reconstruction and Cervical Anastomosis in McKeown Esophagectomy.

Wentao Yang,Donglai Chen,Lei Chen,Jiaheng Zhang,Yonghua Sang

doi:10.3389/fsurg.2021.646811

Abstract

A stomach was considered ineligible to be an ideal conduit conventionally if its right gastroepiploic artery (RGEA) were injured. However, both sufficient blood flow and good venous return are crucial to the success of reconstruction. And there lacks robust evidence regarding the surgical techniques of reconstructing RGEA and right gastroepiploic vein (RGEV) and performing cervical anastomosis with gastric conduit simultaneously. Herein, we summarized the key surgical techniques for simultaneous vascular reconstruction and gastric conduit anastomosis in McKeown esophagectomy.

Highlights

McKeown esophagectomy is the primary surgical procedure for esophageal malignancies
Drugs that constrict peripheral blood vessels should be used with caution, so as to ensure adequate perfusion to the reconstructed right gastroepiploic artery (RGEA)
Enteral nutrition support via jejunostomy was recommended to avoid the physical stimulates from the nutrient tube. Those strategies can eliminate excessive internal tension in the gastric conduit, especially in the pylorus, so as to avoid the local expansion of gastric conduit which may increase the tension of vascular anastomosis

Summary

INTRODUCTION

McKeown esophagectomy is the primary surgical procedure for esophageal malignancies. As RGEA is the primary source of blood supply of the gastric conduit (1), the unavailability of RGEA disallows the stomach as an ideal substitute for esophagus. The key surgical techniques during the vascular reconstruction and cervical anastomosis with gastric conduit has not been fully revealed in McKeown esophagectomy. We summarized the surgical procedures for simultaneous reconstruction of RGEA and RGEV as well as gastric conduit anastomosis in McKeown esophagectomy based on our previous practice. Once acceptable tension was identified at the vascular stumps, the injured vessels could be reconstructed via direct anastomosis promptly. Drugs that constrict peripheral blood vessels should be used with caution, so as to ensure adequate perfusion to the reconstructed RGEA. Minimized tension of vascular anastomosis and gastric conduit anastomosis as follows may be effective to avoid postoperative complications, such as esophageal anastomotic fistula and vascular anastomosis hemorrhage. Strategies can eliminate excessive internal tension in the gastric conduit, especially in the pylorus, so as to avoid the local expansion of gastric conduit which may increase the tension of vascular anastomosis

DISCUSSION

ETHICS STATEMENT