Supradiaphragmatic Roux-en-Y jejunal reconstruction after extended total gastrectomy for gastroesophageal adenocarcinoma

Abstract

Background

Surgical management of gastroesophageal junction adenocarcinoma extending into both the esophagus and the stomach often requires distal esophagectomy and total gastrectomy (extended total gastrectomy). Roux-en-Y jejunal conduits are commonly used for reconstruction; however, concerns exist regarding the ability to obtain adequate length for a supradiaphragmatic anastomosis.

Methods

This retrospective study included patients with esophagogastric adenocarcinoma who underwent extended total gastrectomy at our institution between 2016 and 2023. Clinicopathologic characteristics were analyzed descriptively. Quality of life was assessed using a Likert scale survey. The Roux-en-Y jejunal conduit was constructed by dividing the second and occasionally third jejunal arterial branches to obtain sufficient length. Disease-free survival (DFS) was defined as the time from surgery to recurrence or death from any cause.

Results

Overall, 29 patients were included. The median patient age was 64 years, and 83% of the patients received neoadjuvant therapy. Five patients (17%) had an anastomotic leak, and 9 (31%) had grade 3-4 complications. The median DFS was 4.5 years; 72% of patients had resumed a regular diet by 3 months. Compared with standard esophagectomy patients at our institution, gastrectomy patients had a longer median length of stay (11 days vs 9 days; P = .048) but similar complication rates. With the exception of diarrhea at 2 weeks (worse for gastrectomy patients; mean score, 2.8 vs 1.4; P ≤ .001), quality of life was not statistically different between gastrectomy patients and standard esophagectomy patients.

Conclusions

Supradiaphragmatic Roux-en-Y jejunal reconstruction after extended total gastrectomy for gastroesophageal junction adenocarcinoma is a feasible approach, associated with low complication rates and adequate recovery of quality of life.