Pieter C. van der Sluis, MD, Roy J. J

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Presentation transcript:

Gastric Conduit Resection and Jejunal Interposition for Recurrent Esophageal Cancer Pieter C. van der Sluis, MD, Roy J.J. Verhage, MD, Sylvia van der Horst, MS, Peter D. Siersema, MD, PhD, Weibel W. Braunius, MD, Richard van Hillegersberg, MD, PhD The Annals of Thoracic Surgery Volume 93, Issue 5, Pages 1727-1729 (May 2012) DOI: 10.1016/j.athoracsur.2011.09.076 Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The alimentary tract lumen with tumor visible after the distal esophagus is transected. The tumor (*) is localized 2 cm distal to the esophagogastrostomy. The Annals of Thoracic Surgery 2012 93, 1727-1729DOI: (10.1016/j.athoracsur.2011.09.076) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Transillumination of the mesentery allows the surgeon to select the segment of the jejunum to be harvested. The Annals of Thoracic Surgery 2012 93, 1727-1729DOI: (10.1016/j.athoracsur.2011.09.076) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The distal end-to-end jejunogastrostomy is performed first, placing the jejunal autograft in an isoperistaltic position. The proximal end-to-end esophagojejunostomy (*) is then created with just a little tension on the suture line (lateral view from the left side). The Annals of Thoracic Surgery 2012 93, 1727-1729DOI: (10.1016/j.athoracsur.2011.09.076) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Microvascular anastomoses. Jejunal segment is selected and harvested and the vascular pedicle is dissected. The microvascular arterial end-to-end anastomosis is created between the jejunal branch of the superior mesenteric artery and the superior thyroid artery. The microvascular venous end-to-side anastomosis is created between the venous branch of the jejunal autograft and the internal jugular vein. (CA = carotid artery; E = esophagus, IJV = internal jugular vein; JI = jejunal interposition; Th = thyroid; Tr = trachea.) The Annals of Thoracic Surgery 2012 93, 1727-1729DOI: (10.1016/j.athoracsur.2011.09.076) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions