title: Conservative reconstruction using stents as salvage therapy for disruption of esophago-gastric anastomosis.
abstract: Esophagectomy with extended lymphadenectomy and gastric conduit reconstruction is a radical procedure for the treatment of esophageal cancer that is associated with a high morbidity rate. Gastric conduit necrosis is a fatal complication that occurs in 2% of patients. Conventionally, two-stage salvage surgery consisting of removal of the necrotic gastric conduit followed by reconstruction has been performed; however, this procedure has a high morbidity rate. We describe a 61-year-old man who underwent minimally invasive esophagectomy complicated by slowly progressive gastric conduit necrosis associated with complete neck drainage and a stable overall condition. There was a 2 cm gap in the anastomosis. Because there was no evidence of residual gastric conduit necrosis, a removable, covered self-expanding metal stent (SEMS) was inserted to bridge the anastomosis. The stent was fixed to the patient's ear with silk thread through the lasso on its proximal end to prevent migration. Eight weeks after insertion, the stent was removed easily without any associated complications. The anastomotic defect was completely bridged with granulation tissue, showing progressive epithelialization without leakage or stenosis. The patient was discharged home in good general health. This is the first report of the successful conservative management of esophago-gastric conduit anastomosis disruption with SEMS placement.
authors.affiliation: Taro Oshikiri, Yasuhiro Fujino, Masahiro Tominaga, Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Oshikiri
authors.affiliation: Taro Oshikiri, Yasuhiro Fujino, Masahiro Tominaga, Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Taro Oshikiri, Yasuhiro Fujino, Masahiro Tominaga, Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan.
authors.forename: Ikuya
authors.initials: I
authors.lastname: Miki
authors.affiliation: Taro Oshikiri, Yasuhiro Fujino, Masahiro Tominaga, Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tsuda
authors.affiliation: Taro Oshikiri, Yasuhiro Fujino, Masahiro Tominaga, Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Taro Oshikiri, Yasuhiro Fujino, Masahiro Tominaga, Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujino
authors.affiliation: Taro Oshikiri, Yasuhiro Fujino, Masahiro Tominaga, Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tominaga
authors.affiliation: Taro Oshikiri, Yasuhiro Fujino, Masahiro Tominaga, Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
mesh_terms: D000714:Anastomosis, Surgical; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy; D004945:Esophagoscopy / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011474:Prosthesis Design; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000295:instrumentation*; D012086:Reoperation; D015607:Stents; D013270:Stomach / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Conservative management; Disruption of anastomosis; Esophagectomy; Gastric conduit necrosis; Hanarostent; Self-expanding metal stent