Surgical approach to cervical esophagogastric anastomoses for post-esophagectomy complications

In gastric tube reconstruction, anastomotic leakage and stricture occasionally occur. Additionally, new or recurrent cancer may occur in the esophageal remnant or at the anastomotic site. Such complications, after cervical anastomoses, led to our adoption of a procedure to approach the anastomosis by manubrium and proximal left clavicle resection. This procedure was applied to seven patients between April 2000 and March 2011. The mean age of the patients was 69.9 years (range, 65-76 years); all were men. The mean operative time was 506 min (range, 374-845 min), with an average blood loss of 297 ml (range, 180-606 ml). Esophagogastric anastomoses were performed in two cases, and free jejunal graft transplantations were performed in the remaining five cases; oral intake became possible for all patients. Limited range of motion or other movement disorders of the neck and upper limbs, due to the upper sternum and clavicle resection, were not observed. This invasive surgical procedure can be acceptable for patients who are facing life-threatening consequences or significant decreases in quality of life and are resistant to conservative treatment.