Modification of the procedure for esophageal reconstruction after resection of esophageal cancer

BACKGROUND/AIMS: Reconstruction after esophagectomy is still associated with the highest risk of anastomotic leakage among all of the gastrointestinal anastomoses. In 1994, the reconstruction phase of our procedure was modified aiming to reduce the risk of anastomotic leakage. We evaluated usefulness of our modified procedure. METHODOLOGY: 32 patients before the modification of reconstruction were included in Group A, whereas Group B included 80 patients after the modification. In Group A, a thin gastric tube was constructed along the greater curvature. In Group B, the gastric tube was made thinner and longer. We were able to preserve a vessel feeding the terminal segment of the gastric tube that secured ample blood supply to this segment. The cut end of the cervical esophagus was anastomosed to the posterior wall of the gastric tube near the greater curvature, where adequate blood supply is available, and the anastomotic line was covered with omentum. RESULTS: In Group A, anastomotic leakage occurred in 15.6%. In Group B, minor leaks occurred 2.5%, indicating a marked decrease. CONCLUSIONS: The method of esophageal reconstruction currently performed at our department does not require special techniques, but the occurrence of anastomotic leakage is very low.