title: Jejunal interposition reconstruction with a stomach preserving esophagectomy improves postoperative weight loss and reflux symptoms for esophageal cancer patients.
abstract: BACKGROUND
  Conventional reconstruction after an esophagectomy uses a gastric tube, which commonly causes several postoperative complaints such as gastric acid reflux in long-term survival cases. Intestinal interposition between the remnant esophagus and the stomach is an option to reduce complaints, and in this study, the advantages of jejunal interposition reconstruction with a stomach preserving esophagectomy (SPE) were assessed.
  
  
  METHODS
  Eleven cases of jejunal interposition with an SPE and 16 cases with gastric tube reconstruction as a control were subject to a comparison of operation time, amount of bleeding, postoperative quality of life, and endoscopic findings.
  
  
  RESULTS
  The SPE group had a longer operation time (SPE: 560 ± 121 min, control 414 ± 83 min, P = 0.038), whereas there was no significant difference in blood loss. Postoperative weight loss was significantly recovered in the SPE group (SPE versus control = 94.0 ± 5.4% versus 87.5 ± 4.7% at 3 mo, P = 0.017; 97.2 ± 7.5% versus 85.0 ± 5.2% at 6 mo, P = 0.010), and there was a significant decrease in the occurrence of reflux symptoms such as heartburn, odynophagia, and cough when jejunal interposition with an SPE was done. Furthermore, reflux esophagitis and Barrett's epithelium were found in six out of 12 cases (50%) of the control group by postoperative endoscopy, while no cases in the SPE group had either condition (P < 0.01).
  
  
  CONCLUSIONS
  This reconstruction method is a promising option to improve postoperative quality of life, mainly due to the long-term elimination of reflux esophagitis, which assists in the recovery of postoperative weight loss.
authors.affiliation: Department of Gastroenterological Surgery, Transplant, and Surgical Oncology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Yamada
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shirakawa
authors.forename: Tomoki
authors.initials: T
authors.lastname: Yamatsuji
authors.forename: Leon
authors.initials: L
authors.lastname: Sakuma
authors.forename: Munenori
authors.initials: M
authors.lastname: Takaoka
authors.forename: Takako
authors.initials: T
authors.lastname: Yamada
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Noma
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Sakurama
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Tanabe
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagasaka
authors.forename: Toshiyoshi
authors.initials: T
authors.lastname: Fujiwara
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Naomoto
mesh_terms: D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000517:prevention & control*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D013270:Stomach / Q000601:surgery*; D015431:Weight Loss