Clinical Comparison of Complications Between Esophagogastrostomy and Jejunal Free Transfer After Resection of Thoracic Esophageal Cancer

Shin, Ho Seung; Lee, Jae Jin; Hong, Kee Woo

Abstract

BACKGROUND: Replacement of the esophagus remains a challenge for surgeons involved in esophageal disease. From 1996 to 1999, a total of 27 patients with esophageal cancer underwent free jejunal transfer(12cases) or esophagogastrostomy(15cases). To determine the results such as leakage of anastomosis site, stenosis, reflux esophagitis and operation time, respiratory complications, etc. we reviewed the 4 years experiences. MATERIAL AND METHOD: Palliative bypass surgery or esophageal prosthesis and cancers of the pharyngoesophageal or esophagogastric junction were excluded in this study. Resection was usually peformed through right thoracotomy and anastomosis was made with EEA staplers in esophagogastrstomy. In cases of jejunal free transfer, 6cases of proximal esophagojejunostomy were stapled anastomosed and remaining 6 cases and all distal site were hand-sewn anastomosed. All reconstruction was done through posteromediastinal route. RESULT: There were two mortalities from thoracic esophagogastrostomy and one from jeunal free transfer. Major and minor complications(anastomosis site leakage: 3 cases, graft failure: 2cases etc) occurred in 27 cases. In 15 thoracic esophagogastrostomy cases, 11 patients had mild to moderate reflux esophagitis and 5 patients incurred stricture of the anastomosis. Operation time was about 550 280 minutes in jejunal free transfer, and about 300 160 minutes in esophagogastromy patients.
CONCLUSION
Post operative reflux esophagitis and dysphagia were more frequent in Ivor-Lewis operation group than jejunal free transfer group; however, respiratory complications and operation time were significantly longer in jejunal free transfer group(p<0.05). To minimize the incidence of postoperative reflux esophagitis and dysphagia,patient evaluation focused on jejunal free transfer surgery is better than esophagogastrostomy followed by adequate post operative care.