Comparison of outcomes of pedicled jejunal and colonic conduit for esophageal reconstruction

Abstract

Background: At present, the gastric tube is the first choice for esophageal reconstruction after esophagectomy for various benign and malignant diseases. However, when the stomach is not available, a pedicled jejunum or colon is used to reconstruct the esophagus. The present study aimed to compare the postoperative outcomes and quality of life of patients receiving jejunal and colonic conduits.

Methods: In the present retrospective study, the clinical data of 71 patients with esophageal carcinoma, who received jejunal reconstruction (jejunum group, n = 34) and colonic reconstruction (colon group, n = 37) from 2005 to 2015, were compared.

Results: Compared with the colon group, the jejunum group had a lower incidence of postoperative anastomotic leakage, lesser duration of postoperative drainage, and faster recovery. Furthermore, the scores were better in the jejunum group than in the colon group, in terms of short-term overall quality of life, physical function and social relationships. Moreover, the jejunal group had a significantly lower frequency of pH < 4 simultaneous reflux time > 5 min (N45) and the longest reflux time (LT) at 24 weeks after surgery.

Conclusion: In esophageal cancer, when gastric tube construction is not feasible, a pedicled jejunum may be preferred over a colonic conduit due to lower incidence of acid reflux, anastomotic leakage and higher postoperative short-term quality of life, and rapid postoperative recovery.

Keywords: Esophageal cancer; Gastric remnant; Pedicle jejunum; Postoperative; Reconstruction.

Fig. 1

Flow chart showing the various surgical approaches, conduits and types of gastrointestinal reconstruction performed for the study patients

Fig. 2

Postoperative acid reflux in patients with jejunal and colonic conduits measured using a pH meter. The jejunal group had significantly lower numbers of pH < 4 simultaneous reflux time > 5 min (N45) (a) and the longest reflux time (LT) (b) at 24 weeks, when compared to the colon group

Fig. 3

Comparison of postoperative quality of life (QLQ-C30) questionnaire scores in patients who received jejunal and colonic conduits: (a) overall quality of life, (b) physical functions, (c) social relationships, and (d) pain scores. The error bars represent the standard deviation

Fig. 4

Comparison of postoperative quality of life (QLQ-OES18) supplemental scale scores in patients who received jejunal and colonic conduits: (a) fatigue score, (b) dyspnea score, (c) loss of appetite score, and (d) gastroesophageal reflux score