{"title":"Jejunal and colonic reconstruction after esophagectomy in difficult gastric conduit: a multicenter study and meta-analysis.","authors":"Tomohiko Yasuda, Akihisa Matsuda, Nobutoshi Hagiwara, Keisuke Mishima, Takeshi Matsutani, Satoshi Nomura, Hiroshi Makino, Keisuke Minamimura, Masanori Watanabe, Yoshiharu Nakamura, Hiroshi Yoshida","doi":"10.1007/s00595-025-03105-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>When using the stomach for esophageal reconstruction is not viable, the jejunum or colon is used, but the optimal choice of organ remains unclear.</p><p><strong>Methods: </strong>We conducted this multicenter retrospective cohort study to compare the short-term outcomes of patients who underwent jejunal or colonic reconstruction across four centers between January 2011 and March 2023. We also conducted a meta-analysis of studies published before November 2024 using the Mantel-Haenszel random-effects model to compare cervical anastomosis outcomes between jejunal and colonic reconstruction after esophageal cancer surgery.</p><p><strong>Results: </strong>Vascular anastomosis was more frequent in the jejunal group (n = 16; p = 0.001), whereas simultaneous gastrectomy was more common in the colonic group (n = 13; p = 0.029). No significant differences were observed in anastomotic leakage (31.3 vs. 46.2%, p = 0.466), graft necrosis (6.3 vs. 0.0%, p = 1), or hospital mortality (6.3 vs. 7.7%, p = 1) between the groups. The meta-analysis showed a trend toward reduced leakage for jejunal reconstruction with vascular anastomosis (OR = 0.42, 95% CI = 0.16-1.01, p = 0.05). Other outcomes were similar.</p><p><strong>Conclusions: </strong>The short-term outcomes of jejunal and colonic reconstructions were comparable. Jejunal reconstruction with vascular anastomosis may reduce leakage, but its prognostic benefits remain unclear.</p><p><strong>Trial registration: </strong>no. M-2023-102.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgery Today","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00595-025-03105-y","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: When using the stomach for esophageal reconstruction is not viable, the jejunum or colon is used, but the optimal choice of organ remains unclear.
Methods: We conducted this multicenter retrospective cohort study to compare the short-term outcomes of patients who underwent jejunal or colonic reconstruction across four centers between January 2011 and March 2023. We also conducted a meta-analysis of studies published before November 2024 using the Mantel-Haenszel random-effects model to compare cervical anastomosis outcomes between jejunal and colonic reconstruction after esophageal cancer surgery.
Results: Vascular anastomosis was more frequent in the jejunal group (n = 16; p = 0.001), whereas simultaneous gastrectomy was more common in the colonic group (n = 13; p = 0.029). No significant differences were observed in anastomotic leakage (31.3 vs. 46.2%, p = 0.466), graft necrosis (6.3 vs. 0.0%, p = 1), or hospital mortality (6.3 vs. 7.7%, p = 1) between the groups. The meta-analysis showed a trend toward reduced leakage for jejunal reconstruction with vascular anastomosis (OR = 0.42, 95% CI = 0.16-1.01, p = 0.05). Other outcomes were similar.
Conclusions: The short-term outcomes of jejunal and colonic reconstructions were comparable. Jejunal reconstruction with vascular anastomosis may reduce leakage, but its prognostic benefits remain unclear.
目的:当胃不能用于食管重建时,可采用空肠或结肠,但最佳器官的选择尚不清楚。方法:我们进行了这项多中心回顾性队列研究,比较2011年1月至2023年3月期间四个中心接受空肠或结肠重建的患者的短期预后。我们还使用Mantel-Haenszel随机效应模型对2024年11月前发表的研究进行了荟萃分析,以比较食管癌手术后空肠和结肠重建的宫颈吻合结果。结果:空肠组血管吻合发生率较高(n = 16;P = 0.001),而同时胃切除术在结肠组更常见(n = 13;p = 0.029)。两组间吻合口漏(31.3 vs 46.2%, p = 0.466)、移植物坏死(6.3 vs 0.0%, p = 1)、住院死亡率(6.3 vs 7.7%, p = 1)无显著差异。荟萃分析显示血管吻合重建空肠有减少渗漏的趋势(OR = 0.42, 95% CI = 0.16-1.01, p = 0.05)。其他结果相似。结论:空肠重建和结肠重建的短期疗效具有可比性。空肠重建血管吻合术可减少渗漏,但其预后效益尚不清楚。试验报名:无。m - 2023 - 102。
期刊介绍:
Surgery Today is the official journal of the Japan Surgical Society. The main purpose of the journal is to provide a place for the publication of high-quality papers documenting recent advances and new developments in all fields of surgery, both clinical and experimental. The journal welcomes original papers, review articles, and short communications, as well as short technical reports("How to do it").
The "How to do it" section will includes short articles on methods or techniques recommended for practical surgery. Papers submitted to the journal are reviewed by an international editorial board. Field of interest: All fields of surgery.