title: Importance of additional microvascular anastomosis in esophageal reconstruction after salvage esophagectomy.
abstract: Esophageal reconstruction after salvage esophagectomy in patients who have undergone curative-intent chemoradiotherapy for esophageal cancer is associated with a significant risk of perioperative morbidity and mortality. In particular, anastomotic leakage can cause severe and potentially fatal complications, including mediastinitis and pneumonia. The authors performed esophageal reconstruction with a pedicled right colon graft after salvage esophagectomy in eight patients. To decrease the rate of anastomotic leakage, the authors performed an additional microvascular anastomosis at the distal end of the graft. The distal stumps of the ileocolic artery and vein were anastomosed to the cervical vessels. After surgery, aspiration pneumonia and localized wound infection were observed in two patients each, but slight anastomotic leakage was observed in only one patient. Postoperative swallowing function was satisfactory in all patients. Although the incidence of anastomotic leakage is reportedly high, the authors observed anastomotic leakage in only one of eight patients. The authors believe that additional microvascular anastomosis helps prevent anastomotic leakage, especially in patients who have undergone salvage esophagectomy after curative chemoradiotherapy.
authors.affiliation: Division of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa City, Chiba, Japan. msakurab@east.ncc.go.jp
authors.forename: Minoru
authors.initials: M
authors.lastname: Sakuraba
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kimata
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Hishinuma
authors.forename: Mitsuyo
authors.initials: M
authors.lastname: Nishimura
authors.forename: Naoto
authors.initials: N
authors.lastname: Gotohda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ebihara
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D003106:Colon / Q000637:transplantation*; D004937:Esophageal Fistula / Q000209:etiology / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D004944:Esophagoplasty / Q000379:methods*; D004947:Esophagus / Q000098:blood supply / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D018365:Neoplasm, Residual; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods; D016879:Salvage Therapy; D013524:Surgical Flaps / Q000098:blood supply*