The Management of Esophageal Cancer with Pericardial Involvement and the Vascular Reconstruction of Jejunal Interposition Grafts After Cervical Esophagectomy

Over the past two and a half decades, surgical resection of the esophagus has remained the primary treatment modality for esophageal carcinoma in the absence of systemic metastasis. Despite recent developments in perioperative care for esophagectomy, the surgical approach due to esophageal carcinoma may still be methodologically difficult and challenging. Mortality rates depend on factors related to the patients’ individual clinical conditions. Patient selection, surgical technique, and the experience of the surgeon play important roles in a better outcome. There may be serious cardiac and pulmonary complications after the surgery; therefore, aggressive postoperative and intensive management are also important for superior clinical response. The utility of jejunal conduit for esophageal reconstruction is an important part of surgical evolution due to its’ nature. The use of jejunum provides better positive motility and a lower incidence of reflux and local or systemic infection. This method can be used for different indications, including cervical esophageal carcinoma, failed previous colonic interposition operation, severe esophageal trauma, stricture, and radiation injury. The disadvantages of esophagojejunoplasty may be described as a slightly higher incidence of anastomotic leak by comparing colonic transfer, graft ischemia, and necrosis. Other complications are anastomotic stricture, recurrent laryngeal nerve injury, bleeding, chyle leak, and impaired conduit emptying. Pericardial involvement in esophageal carcinoma is another important clinical condition that usually occurs in the late stages of the disease. It often tends to present with pericardial effusion and cardiac tamponade. Newly developed pleuritic chest pain and dyspnea with jugular venous congestion may be important symptoms and clinical findings. Left atrial compression may lead to mitral insufficiency and pulmonary edema. Tube pericardiocentesis, tube pericardiostomy, and/or opening a pericardial window may be suitable approaches, depending on the patient’s clinical condition. The survival rates of esophageal carcinoma patients with pericardial involvement are still meager.