title: Additional microvascular anastomosis in reconstruction after total esophagectomy for cervical esophageal carcinoma.
abstract: BACKGROUND
  Maintaining sufficient blood flow to the substitute organ after total esophagectomy is essential for decreasing the risk of anastomotic leakage. Additional venous, or arterial and venous, anastomoses between the vessels of the gastric tube and the vessels in the neck after total esophagectomy are described for 11 patients with cervical esophageal carcinoma.
  
  
  METHODS
  The tissue blood flow was measured by laser Doppler flowmetry before and after anastomosis. Venous anastomosis was performed for all 11 patients, and arterial anastomosis was added for 7 patients.
  
  
  RESULTS
  A significant increase in tissue blood flow was observed after venous anastomosis alone (mean, 19%; P < 0.05) and after arterial and venous anastomoses (mean 43%; P < 0.01). There was no anastomotic leakage or hospital death.
  
  
  CONCLUSIONS
  This procedure may reduce the risk of anastomotic leakage especially in the case of pharyngogastrostomy following total esophagectomy.
authors.affiliation: First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Murakami
authors.forename: A
authors.initials: A
authors.lastname: Sugiyama
authors.forename: T
authors.initials: T
authors.lastname: Ikegami
authors.forename: H
authors.initials: H
authors.lastname: Aruga
authors.forename: K
authors.initials: K
authors.lastname: Matsushita
authors.forename: K
authors.initials: K
authors.lastname: Ishida
authors.forename: F
authors.initials: F
authors.lastname: Maruta
authors.forename: T
authors.initials: T
authors.lastname: Ikeno
authors.forename: F
authors.initials: F
authors.lastname: Shimizu
authors.forename: S
authors.initials: S
authors.lastname: Kawasaki
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D004944:Esophagoplasty; D006801:Humans; D017078:Laser-Doppler Flowmetry; D013270:Stomach / Q000601:surgery; D019738:Surgically-Created Structures / Q000098:blood supply; D014656:Vascular Surgical Procedures / Q000379:methods*