Use of revascularized jejunum as a free graft for cervical esophagus

The recent advent of the small vessel suturing apparatus made possible the use of free intestinal segment for reconstruction of the resected cervical esophagus which has been one of the most difficult procedures. In the present communication, successful use of revascularized jejunal segment with Inokuchi's vascular stapler in 13 cases of upper esophageal cancer was reported. Histological examination of the 10 resected specimens revealed that cancer invasion beyond the esophageal adventitia as well as risky cancer remnant at the resected margins were more frequently present when the tumor extended more than 5 cm longitudinally. Therefore esophageal cancer localized within the neck and extending less than 5 cm may well be indicated for the free intestinal transplantation. Details of the operative technique are described.