Nonsupercharged cervical Roux-en-Y esophagojejunostomy for esophageal reconstruction

Area of Science:

• Gastroenterology
• Surgical Oncology
• Reconstructive Surgery

Background:

• Esophageal reconstruction is complex, often requiring alternative conduits when the stomach or colon is unavailable.
• The jejunum presents a potential alternative conduit for esophageal substitution.

Purpose of the Study:

• To evaluate the feasibility and outcomes of using a nonsupercharged jejunal segment for esophageal substitution.
• To assess the safety and efficacy of cervical Roux-en-Y esophagojejunostomy without microvascular anastomosis.

Main Methods:

• Analysis of 22 cases of nonsupercharged cervical Roux-en-Y esophagojejunostomy performed between January 2021 and April 2025.
• Preservation of the first jejunal arterial branch, division of subsequent branches, and performance of the anastomosis without microvascular intervention.
• Collection of patient demographics, perioperative data, quality of life scores at 6 months, and survival outcomes.

Main Results:

• The study included 22 patients (19 male, median age 69), with jejunal conduits primarily used due to prior gastrectomy (81.8%).
• Median operation time was 270 minutes, with a median hospital stay of 11 days (5 days in ICU).
• Anastomotic leakage occurred in 18.2% of cases; however, oral feeding was successful in most patients, and 1- and 2-year survival rates were 0.802 and 0.501, respectively.

Conclusions:

• Cervical Roux-en-Y esophagojejunostomy without microvascular anastomosis is a safe and feasible technique for esophageal reconstruction in selected patients.
• This approach is particularly beneficial for patients with a history of upper gastrointestinal surgery, including Roux-en-Y, Billroth I, Billroth II, or jejunostomy procedures.
• The study supports the jejunum as a viable substitute for esophageal replacement, offering good functional and survival outcomes.