Total esophagogastrectomy plus extended lymphadenectomy with transverse colon interposition: A treatment for extensive esophagogastric junction cancer

Abstract

AIM:To review the post-operative morbidity and mortality of total esophagogastrectomy (TEG) with second barrier lymphadenectomy (D2) with interposition of a transverse colon and to determine the oncological outcomes of TEG D2 with interposition of a transverse colon. METHODS: RESULTS:The series consisted of 21 patients (80.9% men). The median age was 60 years. The 2 main surgical indications were extensive esophagogastric junction cancers (85.7%) and double cancers (14.2%). The mean total surgery time was 405 min (352-465 min). Interposition of a transverse colon through the posterior mediastinum was used for replacement in all cases. Splenectomy was required in 13 patients (61.9%), distal pancreatectomy was required in 2 patients (9.5%) and resection of the left adrenal gland was required in 1 patient (4.7%). No residual cancer surgery was achieved in 75.1% of patients. A total of 71.4% of patients had a postoperative complication. Respiratory complications were the most frequently observed complication. Postoperative mortality was 5.8%. Median follow-up was 13.4 mo. Surgery specific survival at 5 years of follow-up was 32.8%; for patients with curative surgery, it was 39.5% at 5 years.CONCLUSION: TEG for cancer with interposition of a transverse colon is a very complex surgery, and it presents high post-operative morbidity and adequate oncological outcomes. Core tip: Esophagogastric junction cancers are rare tumors that have increased in prevalence in recent decades due to lifestyle changes. Key results of this study are as follows: (1) We describe a treatment for patients with esophago-gastric junction cancer; (2) We show the surgical details in high quality artwork to better represent the surgery; and (3) We show the postoperative and oncological outcomes of this technique.

Complicaciones postoperatorias en esofagectomía por cáncer. Evaluación de 215 casos según definiciones del grupo de consenso internacional.

“…No realizamos piloroplastía. En casos de tumores extensos de la unión gastroesofágica o en pacientes en que no se puede utilizar el estómago para la reconstrucción, realizamos una interposición de colon transverso 12 .…”

Colon Interposition for Esophageal Reconstruction in Cancer Patients

“…32,33 In our small study and in some of the reviewed studies (Table 3), PRCs were seen in about one-third to half of all patients. 4,6,18 Risk factors for the development of pneumonia were age, male gender, active smoking, COLD, diabetes mellitus and transthoracic operative approach (as opposed to transhiatal). Operation time, BMI, and neoadjuvant therapy on the other hand were not identified as risk factors.…”

“…1 The length, acid resistance, and excellent blood supply makes the colon a great interponat, 2,3 but the COI operation is technically demanding with a long operating time and a significant risk of complications. 1,[4][5][6][7] The preferred use of the stomach as conduit and the complexity of the COI have made the latter a somewhat rare operation, and this is reflected in the lack of prospective studies and COI reviews.…”

Simultaneous Esophago-Gastrectomy With Colonic Interposition as a Method of Surgical Treatment of Gastroesophageal Cancer With High Involvement of the Esophagus

“…Сторонники абдомино-цервикальных операций считают, что при переходе опухоли на пищевод выше диафрагмы необходимо выполнять эзофагэктомию с формированием анастомоза на шее [2, 11,12,15,16,20,30,35]. При этом следует отметить, что данная тактика обусловлена не столько прямыми онкологическими показаниями, сколько стремлением перевести пищеводное соединение на шею из-за опасения летальных осложнений в случае развития его несостоятельности.…”

“…Из 44 больных по поводу рака желудка с высоким поражением пищевода оперировано 14, в то время как остальные по поводу синхронного рака пищевода и желудка. В противоположность авторам, приводившим весьма высокий процент послеоперационных осложнений [16] с частотой несостоятельности пищеводно-толстокишечного анастомоза на шее -33,3%, в исследовании ронЦ общая частота осложнений составила 47,7%, а случаев несостоятельности ручного внутригрудного пищеводно-толстокишечного соустья авторами не отмечено.…”