Reconstruction

Oncological esophagectomy for esophageal cancer is a highly invasive procedure. Anastomotic leakage is a major complication, and efforts are needed to reduce the incidence. There are several variations in reconstructive organs, routes, anastomotic locations, and techniques for esophageal reconstruction, and the choice must be made according to each situation. The stomach has an abundant microvascular network and is the first choice for esophageal reconstruction. A narrow gastric tube provides superior length, while a whole stomach provides superior blood flow. Several modifications with the stomach may be helpful in situations where there is insufficient length or poor blood perfusion. If the stomach is unavailable, the jejunum or colon are alternative options. There are three types of colon substitutes: the right colon, the left colon, and ileocolonic grafts. Pedicled jejunal grafts are used in different lengths, depending on the extent of the esophagectomy. Intrathoracic anastomosis is reported to have a lower incidence of anastomotic leakage than cervical anastomosis, but a higher severity of leakage when it does occur. Anastomotic techniques include hand-sewn, circular stapling, and linear stapling, and these differences may affect the risk of anastomotic leakage and stricture. Anastomosis utilizing linear stapling may be advantageous in reducing anastomosis-related complications. Understanding the characteristics of each esophageal reconstruction and appropriately selecting and implementing them will lead to improved surgical outcomes.