Elsevier

Thoracic Surgery Clinics

Volume 16, Issue 1, February 2006, Pages 11-22
Thoracic Surgery Clinics

Esophageal Conduit Necrosis

https://doi.org/10.1016/j.thorsurg.2006.01.003Get rights and content

Section snippets

Stomach

The stomach has become the most commonly adopted substitute for the resected esophagus. It has a blood supply from vessels that are of good size and demonstrate little anatomic variability. The stomach is easy to mobilize for use as a conduit and requires only a single (esophagogastric) reconstructive anastomosis. Properly mobilized, the stomach can be used to replace both short- and long-segment esophageal resections. It is a durable graft, remaining viable and retaining its size, shape, and

Colon

The colon has a longer history of use as an esophageal conduit than the stomach. The colon's unique vascular anatomy led surgeons to realize that segments of the colon could be mobilized as a vascularized graft, long before this methodology became common practice in other settings. The vascular supply to the colon is segmental (right colic, middle colic, inferior mesenteric arcades), and all these vessels feed the marginal artery of Drummond, a vessel that runs in close proximity and parallel

Jejunum

Like the colon, the jejunum has a long history of use as an esophageal replacement conduit. Early in the history of open general surgery, the use of jejunum, especially when mobilized as a Roux-en-Y limb, gave the general surgeon the ability to perform a wide range of reparative and reconstructive surgeries. Advantages of jejunum for esophageal replacement include the lack of need for preoperative bowel preparation, easy mobilization, large mesenteric vessels largely spared from coexisting

Summary

A cumulative review of the prevalence of esophageal conduit necrosis is summarized in Table 4. The spectrum of conduit ischemia is broad and includes cases in which there is anastomotic leak or stricture as well as cases in which there is frank graft necrosis. Many of the studies that the authors reviewed do not specify the exact nature of postoperative ischemic complications or how they are defined. Therefore, postoperative conduit ischemia is reported globally. Based on the authors' review,

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      Conduit necrosis is a death or ischemia of the conduit used in the replacement of the resected esophagus, which is the stomach in ILE. Gastric conduit necrosis is a life-threatening complication following ILE that occurs in 1–3% of patients and has a major impact on postoperative outcomes with a high mortality rate up to 90% [58]. Risk factors that may compromise perfusion and oxygenation of the gastric conduit are the presence of comorbidities such as diabetes mellitus, hypertension, cardiac failure, arrhythmia, and other conditions associated with atherosclerosis.

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      There are a few points to consider, however, when performing esophagectomy in the salvage setting, mainly the radiation dosage and treatment field and their potential impact on the health of the conduit.16,38 For instance, a recent systematic and meta-analysis reported a rate of conduit necrosis in salvage esophagectomy as high as 21%,39 with a mortality rate reaching 90% in another report.40 Risk factors associated with conduit ischemia or necrosis include diabetes mellitus, malnutrition, steroid use, hypertension, cardiac arrhythmias, reduced cardiac contractility, and peripheral vascular disease.41

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