A Clinical Study of the Reanastomotic Cases with Thoracic Esophageal Cancer After Resection and Reconstruction with Special Reference to the Anastomotic Method and Results

Ken Hayashi, Hiroshi Watanabe, Hoichi Kato, Yuji Tachimori

Department of Surgery, National Cancer Center Hospital

During the past 27 years, after resction and reconstruction 53 patients with thoracic esophageal cancer required reanastomosis between the cervical esophagus and the prosthesis. Reanastomosis was performed against leakage (L group) in 32 cases and for stenosis (S group) in 21 cases. Primary closure had been performed in 47 cases, and reconstruction with a local skin flap in 3, with pedunculated jejunal interposition in one and with free jejunal transplantation in two. Releakage after the reanastomosis occurred in 53% and became major leakage in 2l%. Releakage occurred significantly more frequent in the L goup (66%) than in the S group (33%), and was more frequent when reconstruction was by the antesternal route (59%) than by the retrosternal route (43%). Prognostic nutritional index was significantly deteriorated in the former cases. Primary closure with local mobilization for patients who had an anastomotic portion smaller than 1/3 of the circumference, and primary closure with wide mobilization for the patients who had an anastomotic portion between 1/3 and 2/3 of the circumference are adequate methods of reanastomosis. However the incidence of releakage after primary closure or reconstruction by skin or jejunum for patients who had an anastomotic portion larger than 2/3 of the circumference was extremly high. Careful management is recommended for patients who had a preoperative risk factor.

Key words
reanastomosis between the cervical esophagus and prosthesis, releakage after reanastomosis, primary closure with local mobilization, primary closure with wide mobilization

Reprint requests
Ken Hayashi Department of Surgery, National Cancer Center Hospital
5-1-1 Tsukiji, Chuo-ku, Tokyo, 104 JAPAN

Accepted
June 13, 1990

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