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Objective: This observational study was done to know the factors responsible and management of suction pneumothorax after trans-hiatal esophagogastrectomy. Materials and Methods: Progressive observational study of 415 patients who underwent trans-hiatal esophagogastrectomy and 35 patients who underwent trans-abdominal esophago-gastrectomy in last five years, for carcinoma esophagus and followed in immediate post-operative period for suction pneumothorax. Results: Ten patients from trans-hiatal group and two patients from trans-abdominal group complicated with suction pneumothorax in immediate post-operative period. It is the corrugated rubber drain site behind the neck incision close to esophago-gastric anastomosis which is responsible for maximum number of cases of suction pneumothorax. Withdrawal of corrugated rubber drain is the first and effective treatment, if diagnosis is made at an earliest point of occurrence of suction pneumothorax. If pneumothorax and air leak is not diagnosed and treated, then other fatal pulmonary complications can occur. Conclusion: Trans-hiatal esophageal dissection is usually associated with mediastinal pleural breach, so bilateral intercostal tube thoracostomy is a rational part of this surgery. Also close observation in immediate post-operative period is necessary to pick-up suction pneumothorax at an earliest point of suspicion. Keywords: Trans- hiatal suction pneumothorax, Esophagogastrectomy suction pneumothorax.

Background: Locally advanced long Siewert type II tumor requires total gastrectomy and D2 lymphadenectomy with distal esophagectomy and mediastinal lymphadenectomy for curative resection. In this scenario, a laparoscopic transhiatal approach is not feasible, and the conventional left thoracoabdominal approach is associated with increased morbidity. Aims and Objectives: To describe a novel technique of fourth jejunal artery based jejunal conduit for thoracoscopic esophagojejunostomy after laparoscopic esophagogastrectomy. Materials and Methods: The laparoscopic total gastrectomy with distal esophagectomy specimen is extracted through the periumbilical incision. A pedicled jejunal conduit based on the fourth jejunal artery is prepared, and the jejunal conduit is placed in the mediastinum under laparoscopic guidance. Using the thoracoscopic approach in a prone position, additional esophageal clearance and subcarinal lymphadenectomy are performed. Handsewn end to side esophagojejunostomy is performed at the level of the carina. Results: Three patients with long Siewert type II underwent this procedure after neoadjuvant chemotherapy. None of the patients had conduit related complications. All three patients had abdominal lymph node involvement and two patients had mediastinal lymph node involvement. Conclusion: Pedicled jejunal conduit based on the fourth jejunal artery is safe for intrathoracic anastomosis after minimally invasive esophagogastrectomy for locally advanced Siewert type II tumor.

Cases of esophagogastrectomies in case of combined cancer of the esophagus and cardia have been described. Indications and operation techniques have been discussed., Описаны случаи эзофагогастрэктомийпо поводу сочетанного рака пищевода и кардии. Обсуждены показания и методики операций., Описані випадки езофагогастректомій з приводу поєднаного раку стравоходу та кардії. Обговорені показання та методики операцій.

We describe a case of total esophagogastrectomy with colonic pull-up, in a case which was initially planned for an Ivor Lewis approach. Reconstruction was done using antiperistaltic left colon conduit based on left branch of middle colic artery. What inspired us to write this report is that, this procedure finds place in many discussions of various studies but nowhere is its detailed technique described. Gastric conduit is the workhorse of esophageal cancer surgery, but sometimes an alternative is required when primary conduit has failed or the stomach is not available due to previous surgery or disease extension.

Cardiac metastasis is uncommon and rarely diagnosed antemortem. Here, we describe a case of symptomatic cardiac metastasis from esophageal adenocarcinoma. A 64-year-old man developed chest symptoms 26 months after curative esophagogastrectomy for esophageal adenocarcinoma. Initially, ischemic cardiac disease was suspected based on electrocardiography findings, but an infiltrative tumor was seen morphologically in the wall of the interventricular septum and apex. No other lesions were detected. Histological examination of a transcatheter biopsy specimen indicated that the cardiac tumor was metastasis from esophageal adenocarcinoma. Chemoradiotherapy with cisplatin relieved his symptoms, and he had resumed normal activities. However, he opted not to undergo further aggressive treatment due to severe adverse effects from cisplatin. Seventeen months after completion of chemoradiotherapy, metastases to the right ventricle and the left thighbone were detected and he died 27 and 24 months after the diagnosis of cardiac metastasis and completion of chemoradiotherapy, respectively.

A esofagectomia é o tratamento curativo do câncer de esôfago não metastático atualmente. Contudo ainda há falta de evidências fiéis que mostrem uma diferença significativa entre as técnicas cirúrgicas e permanece a controvérsia sobre a localização anatômica ideal da anastomose esofagogástrica, intratorácica ou cervical. O objetivo desse estudo foi avaliar a influência do local da anastomose, cervical ou torácica, nas complicações operatórias e mortalidade da esofagogastrectomia com linfadenectomia em dois campos.

Background: As treatment of esophageal carcinomas continues to improve, we have seen an increasing population of long-term survivors giving rise to the observation of additional primary malignancies not previously seen. Esophagogastrectomy for previously treated esophageal carcinoma presents unique anatomic changes providing further technical difficulties for surgical management of new primary malignancies. Presentation: A 65-year-old male with a history of esophagogastrectomy for esophageal adenocarcinoma presents with a pancreatic head mass consistent with pancreatic adenocarcinoma. Our case report describes a pylorus sparing pancreaticoduodenectomy with preservation of the right gastric and right gastroepiploic vessels in order to preserve blood supply to the gastric conduit. Conclusion: Here we demonstrate that in select cases where location of the pancreatic head tumor is favorable, pancreaticoduodenectomy can be performed in the context of prior esophagogastrectomy with preservation of the native blood supply to the gastric conduit. Pancreaticoduodenectomy may have yet been possible if the tumor involved the gastroduodenal artery via vascular reconstruction to the right gastroepiploic artery or sacrifice of the gastric conduit with reconstruction using small or large intestine.

Outcomes after open esophagogastrectomy (OE) have been shown to depend on institution case volume. We aim to determine whether a similar relationship exists for minimally invasive esophagogastrectomy (MIE).Patients who had OE or MIE (excluding robotic procedures) between 2010 and 2013 in the National Cancer Database were included. Outcomes included 30-day and 90-day mortality, length of stay, hospital readmission, margin positivity, and number of lymph nodes harvested. Logistic and linear regression were used to adjust for possible confounders including age, sex, tumor size, Charlson score, induction therapy, and type of institution (academic versus community based).We identified 2371 patients in the MIE group and 6285 patients in the OE group. In multivariate analysis, high case volume was an independent predictor for lower 30-day mortality and 90-day mortality, shorter length of stay, and higher rate of negative-margin resection in OE (P.001) but not in MIE. After quartile ranking of institutions based on volume, MIE outcomes were found to be better in institutions in the highest volume quartile compared with those in the lowest (P.001).In this dataset, MIE postoperative outcomes, unlike OE postoperative outcomes, did not correlate with hospital case volume. Volume-outcome relationships may be affected by surgical approach. The effect of case volume on long-term outcomes after MIE warrants further study.

Background/aim Circumferential resection margin involvement is an independent prognostic factor in patients with adenocarcinoma of the distal esophagus and esophago-gastric junction. However, there is currently no consensus on the extent and the technique of hiatal dissection. We describe a minimally invasive technique of circumferential hiatal dissection for adenocarcinoma of the distal esophagus and esophago-gastric junction with its related histopathological results. Patients and methods A prospective study of 40 consecutive patients undergoing hybrid (laparoscopic/thoracotomic) or totally minimally invasive Ivor-Lewis esophagogastrectomy over a period of 21 months was conducted. Dissection of the hiatus included peri-esophageal surrounding tissues in a cylindrical fashion maximizing the distance from the oesophageal wall. Crural muscle fibers and pleura bilaterally, pericardial fat anteriorly and pre-aortic tissue posteriorly were excised en bloc. Histopathological results particularly focused on involvement of the circumferential resection margin. Neoadjuvant chemotherapy was given to 24 (60%) patients. Results Complete histological clearance (R0) was achieved in 92.5% (n=37) according to the criteria of the College of American Pathologists and in 87.5% (n=35) according to those of the Royal College of Pathologists. In pT3 tumors (n=22), the circumferential resection margin was negative in 20 patients (91%) according to the College of American Pathologists, and in 17 (77%) according to the Royal College of Pathologists. Conclusion Adoption of this safe and reproducible technique might reduce the incidence of circumferential resection margin involvement and improve pathological outcomes. In addition, there may be positive implications for training and quality control.

Objective Fluid therapy is one of the key components of perioperative management. However, evidence of intraoperative fluid (IOF) administration affecting clinical outcomes following McKeown esophagogastrectomy remains limited. This study investigated the impact of IOF on clinical outcomes after McKeown esophagogastrectomy. Methods Patients who underwent McKeown esophagogastrectomy between July 2013 and July 2016 were identified. Preoperative, intraoperative and postoperative variables for each eligible patient were retrospectively collected from our electronic medical records and anesthetic records. IOF rates were determined and their relationships to postoperative clinical outcomes were compared. Results A total of 546 patients were enrolled in the analysis. The median IOF rate was 8.87 mL/kg/h. We divided the patients into two groups: a low fluid volume group (LFVG

Esophagectomy remains an operation with potential high morbidity and mortality. Minimally invasive esophagectomy (MIE) has gained popularity over the last two decades as an oncologically equivalent alternative to open esophagectomy. The first reports of robotic-assisted minimally invasive esophagectomy were published in the early 2000s. The surgical robot offers several advantages: multiple arms which allow the surgeon to assist himself and furthermore provide superior instrument dexterity and stable high-definition and stereoscopic visualization. This chapter outlines the evolution of esophagectomy from open to minimally invasive robotic technique and details the technical aspects of robotic Ivor Lewis Esophagogastrectomy.

Background Pedicled jejunal flap can be utilized with various tips for esophageal reconstruction in patients with a history of gastrectomy or those who have undergone synchronous esophagogastrectomy. However, the rate of anastomosis leakage is high; therefore, we considered the evaluation of blood flow of the remnant esophagus with indocyanine green in setting the anastomosis site. Methods Fifty patients who underwent radical esophagectomy with pedicled jejunal flap between January 2011 and June 2020 were identified. From June 2019, blood flow in the pedicled jejunum and remnant esophagus were evaluated to set the anastomosis site of the latter. Usually, the second and third jejunal vessels are transected, and if the jejunal flap cannot reach to the anastomosis point, we actively transect the marginal vessels to stretch the jejunal flap. Microvascular anastomosis between the jejunal branches and the internal thoracic vessels is usually made, and the anastomosis site is set at the well-stained part of the esophagus. Results Overall, 39 patients underwent the procedure before June 2019 (Group A), and 11 patients underwent the procedure since June 2019 (Group B). No significant difference was found in the patients’ background, type of preoperative therapy, presence or absence of ligation of marginal vessels and two-stage operation between the groups. Group A had 16 cases of anastomosis leakage; B had only 1 case (p, Highlights • ・Pedicled jejunal flap can be utilized with various tips for esophageal reconstruction, although the rate of anastomosis leakage is high. • ・we considered the utility of the evaluation of blood flow of the remnant esophagus with indocyanine green in setting the anastomosis site. • ・The anastomosis site is set at the part of the esophagus that is well-dyed with indocyanine green. • ・Our findings demonstrate that the evaluation of the blood flow of the remnant esophagus during setting of the anastomosis site may decrease the rate of anastomosis.

Highlights • Endoscopic vacuum (endovac) therapy has excellent results for esophageal leaks. • Endovac therapy has results superior to stents and can treat resistant leaks. • Endovac therapy is well tolerated and feasible in the community setting. • Commercial devices need to be manufactured to facilitate endovac placement., Introduction Endoscopic vacuum (endovac) therapy has shown excellent outcomes when used for esophageal anastomotic leaks. The results of endovac therapy are superior to those of other endoscopic therapies for esophageal leaks. Case presentation We present a case of a 70-year-old male with esophageal adenocarcinoma who underwent Ivor Lewis esophagogastrectomy that was complicated by an esophageal leak. After failure of multiple endoscopic therapies (i.e. stents and clips), he responded well to endovac therapy. Discussion Endovac therapy is extremely useful for the treatment of esophageal leaks. The widespread use of endovac therapy is feasible, even in smaller community hospitals. Conclusion Endovac therapy is a valuable tool that can be used widely for the management of esophageal leaks. Commercially available devices need to be developed in order to facilitate endovac placement and exchange so that the procedure is less dependent on the skill of the operator.

Background Inflammatory fibroid polyps (IFP), known as Vanek tumors, are benign neoplasms, usually located in the stomach and small bowel. The prognosis is good in long term. Clinical case We report a 24-year-old woman, with 3 days history of abdominal pain located in the epigastrium, accompanied by melenic evacuations and weight loss since the last month, making the diagnosis of inflammatory fibroid gastric polyp by means of the upper endoscopy and biopsy. Conclusions IFP are extremely rare neoplasms in the Mexican population. The symptoms range from asymptomatic, epigastralgia, anemia, and weight loss to intestinal obstruction. Its diagnosis is histopathological.

The present study aimed to introduce a novel method of cervical esophagogastric anastomosis, so-called ‘modified one-piece mechanical anastomosis’ (MOMA) in McKeown esophagogastrectomy and to compare its feasibility, efficacy and safety with those of ‘conventionally double-layer hand-sewn anastomosis’ (CDHA). Between March 2016 and March 2018, 80 consecutive patients with thoracic esophageal squamous cell carcinoma undergoing McKeown esophagogastrectomy with a curative intent were included in the present study. Among them, 40 received MOMA and the other 40 received CDHA. Their medical records, including operation time, anastomotic time, estimated blood loss, postoperative complications within 30 days, as well as survival rate, were retrospectively reviewed, analyzed and compared. Total operation time, anastomotic time and estimated blood loss in the MOMA group were significantly decreased compared with those in the CDHA group (207.73±2.66 vs. 225.40±3.43 min; 10.95±0.44 vs. 23.03±0.47 min; 144.50±21.14 vs. 241.75±23.75 ml; all P0.05). Furthermore, the disease-free and overall survival was compared by means of Kaplan-Meier survival estimates and log-rank tests and no statistical difference was determined (P=0.5114 and P=0.7875, respectively). McKeown esophagogastrectomy with MOMA may be a feasible, effective and reproducible alternative with relatively satisfactory postoperative outcomes for the treatment of TE-SCC, providing shorter operation and anastomosis times, and less estimated intraoperative blood loss.

This study was about a 70-year-old man with progressive dysphagia. Esophagogastroduodenoscopy showed a 1.2-cm circumferential ulcerative mass at the level of 23 cm from the upper incisors in the upper esophagus. The mass was first diagnosed as a poorly differentiated squamous cell carcinoma. McKeown esophagogastrectomy was performed with intention to treat the lesion. The pathological examination showed an esophageal neuroendocrine carcinoma that was mixed with squamous cell carcinoma component. In this report, we present a unique case of the extremely rare esophageal neoplasm, an esophageal neuroendocrine carcinoma with squamous cell carcinoma component.

To evaluate short-term and long-term outcomes of laparoscopic-assisted transhiatal esophagogastrectomy (LTEG) for treatment of adenocarcinoma of the esophagogastric junction (AEG).Patients with AEG who underwent laparoscopic or open surgery at our department from October 2008 to December 2012 were enrolled in this retrospective study. Patients' demographics, perioperative outcomes, and survival data were collected.A total of 136 patients with AEG were enrolled (103 patients underwent laparoscopic surgery and 33 patients underwent open surgery). Patient characteristics were comparable between two groups in terms of age, gender, tumor-node-metastasis stage, tumor size, preoperative complications, and type of surgery. The median operative time was longer in laparoscopic group (240 versus 210 minutes, P = .048). However, the estimated blood loss was less, and the rate of pleural rupture was lower in laparoscopic group (20 versus 70 mL, P .001 and 18.4% versus 36.4%, P = .033, respectively). The rate of patients with pleural rupture requiring prolonged use of mechanical ventilation longer than 12 hours (6/31, 19.4%) was higher than that of patients without pleural rupture (6/105, 5.7%) (P = .019). The incidence of reflux symptoms at postoperative month six was similar in two groups (18.4% in laparoscopic group versus 24.2% in open group, P = .468), as well as the use of proton pump inhibitors (12.6% versus 15.2%, P = .709). Furthermore, the number of lymph nodes harvested (22 versus 25), 2-year cumulative overall survival rates (80.4% versus 57.5%), and the median survival times (51.52 months versus 24.24 months) were similar between two groups (P .05).LTEG is a safe, feasible, and oncologically effective procedure for AEG when performed by an experienced surgeon. Laparoscopic surgery is associated with a lower risk of pleural rupture, but pleural rupture in laparoscopic surgery may cause an adverse effect on the recovery of pulmonary function presumably due to tension pneumothorax.

Background Postoperative chylothorax in children is associated with an increased risk of vascular thrombosis, hypothesized to be from loss of antithrombin into chylous fluid resulting in a hypercoagulable state. In adults, an increased thrombotic risk with chylothorax has not been described. Adults undergoing Ivor-Lewis esophagogastrectomy have two strong thrombotic risk factors—active malignancy and postoperative state—allowing for relative homogeneity in baseline thrombotic risk; therefore, we studied the association of chylothorax with thrombosis in this population. Methods We performed a single-center retrospective cohort study at a tertiary care academic center. Patients included adults undergoing Ivor-Lewis esophagogastrectomy between January 1, 2006, and December 31, 2012. We collected demographics, pleural fluid characteristics, and relevant imaging within 30 days after the operation. Using nominal logistic regression, we studied the effects of chylothorax, age, sex, body mass index, American Society of Anesthesiologists Physical Status Classification, operative duration, and hospital length of stay on the incidence of postoperative thrombosis. Results We identified 608 patients who underwent Ivor-Lewis esophagogastrectomy. Of these, 524 (86.2%) had no pleural fluid analysis, 48 (7.9%) had nonchylous effusions, and 36 (5.9%) had chylothoraces, with incident acute vascular thrombosis within 30 days postoperatively occurring in 22 of 524 (4.2%), 2 of 48 (4.2%), and 8 of 36 (22.2%), respectively ( p = 0.001). In multivariate analyses, after adjusting for the above factors, chylothorax was associated with significantly higher odds of any vascular thrombosis (odds ratio, 5.46; p = 0.0013) and deep venous thrombosis/pulmonary embolism (odds ratio, 6.76; p = 0.0016). Conclusions Chylothorax is associated with a significantly higher incidence of vascular thrombosis in adults undergoing Ivor-Lewis esophagogastrectomy. Vascular thrombosis was associated with a significantly higher 90-day mortality rate.

Background: Esophagectomy in situs inversus is challenging. With long-segment supercharged reconstruction, it becomes more perplexing and multidisciplinary surgical skills are needed. Challenges met and the surgical technique used is presented in this case report. Methods: The case of a 49-year old patient with situs inversus abdominus and a locally advanced distal esophageal adenocarcinoma extending to the stomach is presented. Results: Following neoadjuvant chemotherapy and due to inability to use the stomach as a conduit, a thoracoscopic total esophagogastrectomy with long-segment reconstruction was performed. The conduit used was the left colon and was supercharged with venous and arterial anastomoses in the neck. Conduit perfusion, as assessed by the Spy system revealed marked improvement post supercharging. No anastomotic leak was noted and oral diet was started on day 4. On day 26 the patient developed pneumonia necessitating intubation that was declined. Organ support was withheld with patient death at day 29. Conclusion: In long-segment esophageal reconstruction with supercharged colon, although thoracoscopy is feasible, laparoscopy is found unsafe. Careful preoperative planning and colon assessment via computed tomography(CT) colonography/angiography and a multidisciplinary team approach is recommended. Adjuncts to assess conduit perfusion like the Spy system are helpful. Supercharging the long colonic conduit is a way of minimizing ischemia-related complications.

Esophageal cancer rarely grows as an intramural tumor with an intact surface epithelium. A previous report described submucosal tumor-like esophageal cancer that had an overlapping morphological phenotype similar to that of a cutaneous sweat gland tumor. Here, we encountered another case of submucosal esophageal cancer mimicking skin adnexal carcinoma. A man in his early 60s who presented with difficulty in swallowing was admitted to our hospital. He had a 30 × 30 mm submucosal tumor in the abdominal esophagus and underwent partial esophagogastrectomy. Histopathological examination revealed that the tumor was composed of cord-like squamoid cell nests that was partially accompanied by gland structure in the inner layer, as found in cutaneous squamoid ductal eccrine carcinoma. The tumor exhibited CK7 immunoreactivity as did the neighboring dilated ducts of the esophageal gland. We describe a unique submucosal tumor-like esophageal cancer that had overlapping morphological features with squamoid ductal eccrine carcinoma and putatively originated in the esophageal submucosal gland ducts.

Background The surgical treatment of Siewert type II adenocarcinoma of the esophagogastric junction (AEG) is controversial, and no systematic technology has been established. The aim of this retrospective study is to introduce the technology of transthoracic single-port assisted laparoscopic esophagogastrectomy. Methods Data from patients with Siewert type II AEG who underwent transthoracic single-port assisted laparoscopic esophagogastrectomy in Guangdong Provincial Hospital of Chinese Medicine from May 2017 to December 2020 were analyzed. Results A total of 35 patients, including 30 males and 5 females, were enrolled in this study. Eight patients underwent proximal gastrectomy while the other 27 patients underwent total gastrectomy. The median operative times were 247.5 (195.0-275.0) min and 290.0 (173.0-530.0) min for proximal and total gastrectomy, respectively. The median lower mediastinal lymph node dissection (LMLD) time was 41.5 (20.0-57.0) min and the median estimated blood loss was 100.0 (20.0-200.0) mL. The median number of harvested mediastinal lymph nodes was 5 [2-13]. Lower mediastinal lymph node metastasis occurred in 9 patients (25.7%). The lower mediastinal lymph node metastasis rate was significantly higher in patients with esophageal involvement exceeding 2 cm [>2 vs. ≤2 cm: 55.6% (5/9) vs. 15.4% (4/26), P=0.03]. The median postoperative hospital stay was 10 [6-73] days. Overall morbidity was 11.8% (4 patients), including 2 cases of pleural effusion, 1 case of pancreatic fistula, and 1 case of anastomotic leakage. Conclusions Transthoracic single-port assisted laparoscopic esophagogastrectomy is safe and feasible. It has the advantages of reducing the difficulty of LMLD and digestive tract reconstruction.

Background Anastomotic stricture following esophagogastrectomy (EG) can lead to significant dysphagia, necessitating interventions such as endoscopic dilatation. These post-operative complications gain importance with the increased survival rate of patients after EG. This study aimed to assess the outcomes of both circular-stapled (CS: 25 and 29 mm) and hand-sewn (HS) anastomoses after EG. Methods We reviewed prospectively accrued data from December 2004 to December 2014 identifying all patients undergoing EG for esophageal cancer. Immediate post-operative and long-term complications were noted. Primary outcome measures included anastomotic leak and stricture, dysphagia, and subsequent. Results A total of 142 patients were identified for analysis. The method used for reconstruction was noted: CS-EEA-25 mm (n = 30), CS-EEA-29 mm (n = 30), and HS (n = 82). Demographics, tumor pathology, and tumor locations were similar in each group. All groups experienced similar rates of anastomotic leak, stricture, and dysphagia. Furthermore, post-operative dilations for symptomatic dysphagia were required in 3 (10%), 4 (13%), and 9 (11%) patients, P = 0.91. Conclusion In this cohort, the method of anastomotic construction had no bearing on the rate of complications after EG for the treatment of esophageal cancer. Furthermore, long-term need for dilations for symptomatic dysphagia was equal among all groups.

The Siewert classification system for gastroesophageal junction adenocarcinoma has provided morphological and topographical information to help guide surgical decision-making. Evidence has shown that Siewert I and III tumors are distinct entities with differing epidemiologic and histologic characteristics and distinct patterns of disease progression, requiring different treatment. Siewert II tumors share some of the characteristics of type I and III lesions, and the surgical approach is not universally agreed upon. Appropriate surgical options include transthoracic esophagogastrectomy, transhiatal esophagectomy, and transabdominal extended total gastrectomy. A review of the available evidence of the surgical management of Siewert II tumors is presented. Careful review of the data appear to support the fact that a satisfactory oncologic resection can be achieved via a transabdominal extended total gastrectomy with a slight advantage in terms of perioperative complications, and overall postoperative quality of life. Overall and disease-free survival compares favorably to the transthoracic approach. These results can be achieved with careful selection of patients balancing more than just the Siewert type in the decision-making but considering also preoperative T and N stages, histological type (diffuse type requiring longer margins that are not always achievable via gastrectomy), and the presence of Barrett’s esophagus.

Esophagocoloplasty represents a useful technique to restore the intestinal continuity after esophagogastrectomy. This technique has been used mainly after esophagogastric caustic injuries. The aim of this review is to assess the role of esophagogastrectomy with esophagocoloplasty for esophageal or gastric neoplasms. A systematic literature search was performed using Embase, Medline, Cochrane, and PubMed databases to identify all studies published in the previous 25 years (1991–2016) reporting cases of esophagocoloplasty after esophagogastrectomy for malignancies. The systematic review was conducted according to the PRISMA guidelines. The systematic review of the literature shows a morbidity rate of 57% and a mortality rate of 15% in the 93 reported cases of esophagocoloplasty performed for malignant diseases. However, R0 rate ranged from 76.1 to 85%, and 5-year survival was obtained in 11.9–32.8% of patients in the different series. In highly selected cases of primary or relapsing gastric or esophageal neoplasms, esophagogastrectomy with esophagocoloplasty is a viable and useful option, which may guarantee complete tumor resection and long-term survival.

Background The surgical approach (transthoracic or transabdominal) for patients with Siewert type II adenocarcinoma of the esophagogastric junction (AEG) still remains controversial. We made a bold attempt to adopt the modified Ivor-Lewis surgery, No turning over, thoraco-laparoscopic esophagogastrectomy, two-field lymphadenectomy and intrathoracic anastomosis, to observe the clinical application and effect. Method Data of patients with Siewert type II AEG were collected in the Hebei General Hospital from June 2017 to February 2019. The operation time, surgical blood loss, the number of dissected lymph nodes, duration of drainage tube, postoperative complications, the length of postoperative hospital stay were collected to assess the safety and feasibility of modified Ivor-Lewis surgery. Results A total of 20 patients with Siewert type II AEG were analyzed in our research, there was no case of turning to thoracotomy, laparotomy or death during the operation.The average operation time, surgical blood loss, amount of dissected lymph nodes, duration of drainage tube, postoperative hospital stay of all enrolled patients was 4.67, 0.57 h, 156, 56.80 ml, 22.55, 3.91, 8.6, 2.21 days, 12.85, 2.5 days respectively. Among all the enrolled patients, one patient(5%) developed anastomotic fistula and one patient(5%) developed hematemesis after operation, eventually, these two patients were discharged successfully. Conclusion For patients with Siewert type II AEG, The modified Ivor-Lewis surgery, No turning over, thoraco-laparoscopic esophagogastrectomy, two-field lymphadenectomy and intrathoracic anastomosis, is safe and feasible. The feasibility and safety could be further and better investigated with a RCT to achieve more conclusive results.

Alport–leiomyomatosis syndrome is an extremely rare condition occurring at a young age in which Alport syndrome coexists with diffuse leiomyomatosis of the digestive tract (primarily the esophagus). Most patients with diffuse esophageal leiomyomatosis require esophagectomy of variable extents. A 20-year-old man with Alport–leiomyomatosis syndrome was diagnosed with dysphasia and hematuria in childhood. Although he underwent partial esophagogastrectomy at 8 years of age, extremely severe gastroesophageal reflux symptoms were noted postoperatively. He was diagnosed with refractory severe reflux esophagitis associated with diffuse leiomyomatosis and esophagogastric anastomosis, for which he underwent subtotal esophagectomy, gastric tube reconstruction, and esophagogastric anastomosis in the left neck. The postoperative course was generally good, and he had no postoperative reflux symptoms. To achieve long-term control of symptoms, the lesion must be removed completely; nevertheless, unnecessarily extensive esophagectomy should be avoided.

Background Aortoenteric fistula (AEF), occasionally reported as a fatal complication after aortic or other vascular procedures, is a communication between the aorta and the digestive tract. AEF as a fatal complication of overlap esophagojejunostomy after esophagogastrectomy has not been reported previously. Herein, we report a case of AEF after laparoscopic proximal gastrectomy and transhiatal lower esophagectomy for cancer of the esophagogastric junction, in which linear staplers were used for overlap esophagojejunostomy. Case presentation A 66-year-old woman with advanced cancer of the esophagogastric junction underwent laparoscopic proximal gastrectomy and transhiatal lower esophagectomy with abdominal and lower mediastinal lymphadenectomy. Double tract reconstruction by the overlap method was performed. The patient was discharged from the hospital 10 days after surgery with a good postoperative course. However, she developed sudden-onset massive hematemesis and melena the day after discharge, resulting in death. Autopsy revealed that the stapled edge of the entry hole of the overlap esophagojejunostomy was in direct contact with the descending aorta. AEF was found at the esophagojejunostomy site. Conclusions To our knowledge, this is the first report of AEF as a fatal complication of overlap esophagojejunostomy after esophagogastrectomy. Although we could not definitively identify the cause of the AEF, it could be attributed to direct contact between the stapled edge and the bare thoracic aorta over a period of 10 days. To avoid direct contact with the aorta in esophagojejunostomy with linear staplers, all stapled edges should be covered by suturing and attention should be paid to the position of these edges.

Aim. To analyze whether the change of laboratory tests (postoperative day 1 (POD1) minus pre-operation) could be predictive factors for postoperative infection in patients who have undergone McKeown esophagogastrectomy. Methods. We retrospectively investigated the clinical data of 358 patients who have undergone McKeown esophagogastrectomy, and divided them into infection and noninfection groups. SPSS 22.0 software was performed for data analysis. Results. In the two groups, smoking status (66.7% vs. 42.3%; P=0.014), male gender (86.1% vs. 72.0%; P<0.001), hoarseness (23.6% vs. 8.7%; P<0.001), poor coughing ability (51.4% vs. 9.1%; P<0.001), the change of WBC count (5.59 ± 4.75 × 109/L vs. 4.51 ± 4.11 × 109/L; P=0.05), the change of glucose (6.03 ± 3.97 g/L vs. 3.78 ± 3.18 g/L), the change of ALB (−12.83 ± 3.45 g/L vs. −10.69 ± 3.86 g/L), the change of CRE (0.17 ± 19.94 umol/L vs. −4.02 ± 15.40 umol/L, P=0.047) were significantly different. These factors were assessed using logistic regression analysis, and factors with P≤0.05 in the univariate analysis were entered into multivariate analysis based on the forward stepwise (conditional) method. Poor coughing ability (odds ratio [OR], 11.034, 95% confidence interval [CI], 5.358–22.724), smoking status (OR, 4.218; 95% CI, 2.110–8.431), the change of WBC count (OR, 1.079; 95% CI, 1.000–1.164), the change of serum ALB level (OR, 0.849; 95% CI, 0.772–0.935), and the change of blood glucose levels (OR, 1.237; 95% CI, 1.117–1.371) were determined as independent risk factors for postoperative infection. We established a scoring system based on these 5 factors, and the area under the curve for this predictive model was 0.843 (range, 0.793–0.894); the sensitivity, specificity, and cut-off score were 70.8%, 85.3%, and 2.500, respectively. Conclusion. Poor coughing ability, smoking habit, the high change of WBC and blood glucose levels, and low change of serum ALB levels can be used to predict the occurrence of postoperative infections among patients who have undergone McKeown esophagogastrectomy.

Feeding jejunostomy tubes (FJT) in patients undergoing resection of gastroesophageal cancers facilitate perioperative nutrition. Data regarding FJT use and complications are limited. A single institution review was performed for patients who underwent perioperative FJT placement for gastrectomy or esophagogastrectomy from 2007 to 2015. FJT-related and unrelated complications were evaluated. FJTs were inserted for total/completion gastrectomy (n = 49/117, 41.9 %), proximal gastrectomy (n = 7/117, 6.0 %), or esophagogastrectomy (n = 61/117, 52.1 %). Ninety percent (n = 106/117) of patients used an FJT at some time point. Although the majority of patients (75.2 %) used FJTs after discharge, 8.5 % (n = 10/117) never used the FJT and 10.3 % (n = 12/117) used the FJT only during hospitalization. Overall, 44.4 % (n = 52/117) had FJT-related complications, including dislodgement (n = 22), clogging (n = 13), and leakage (n = 6). The majority of FJT complications were resolved by telephone triage (13.5 %) or bedside/clinic intervention (57.7 %), but 3.4 % required operative intervention for small bowel obstruction (n = 3) and hemorrhage (n = 1). FJT complications were more common with gastrectomy than esophagogastrectomy (53.6 vs. 36.0 %), perhaps related to longer FJT use in gastrectomy patients (71 vs. 38 days). FJT-related complications are common, occurring more frequently after gastrectomy than esophagogastrectomy. In most patients, complications can be managed by simple measures, rarely requiring operative intervention. Nevertheless, the need for FJTs should be carefully considered to balance nutritional benefits with the risks of insertion and usage.