Colonic esophagoplasty with planning in esophageal and gastroesophageal junction carcinomas surgical treatment

The effectiveness of the colonic esophagoplasty planning method for surgical treatment of esophageal and gastroesophageal junction carcinomas is evaluated by analyzing factors that affect the mortality risk from respiratory complications and other causes. Colonic esophagoplasty in cases of non-transplanted stomach was performed in 109 patients with esophageal carcinomas – 66.1 % (72/109) and gastroesophageal junction carcinomas – 33.9 % (37/109). Esophagoplasty was performed using the planning method (selective angiography and trial clamping of vessels) which was applied in 40.4 % (44/109) patients. The method effectiveness was evaluated by determining the effect of mortality risks (hazard ratio – HR) from respiratory complications (aspiration pneumonia and adult respiratory distress syndrome) and other causes. Postoperative morbidity was determined in 66.8 % (73/109) observations. Graft necrosis was diagnosed in 7.3 % patients (8/109), esophageal anastomosis leakage without graft necrosis – in 5.5 % patients (6/109), pneumonia – 14.7 % patients (16/109) patients, pulmonary and heart failure – in 5.5 % patients (6/109), pulmonary artery thromboembolism – in 0.9 % patients (1/109). The use of the planning method reduced the mortality risk from respiratory complications and from other causes (HR 0.46 [95 % CI 0.24–0.89], p Cox = 0.021 and HR 0.52 [95 % CI 0.29–0.95], p Cox = 0.034, respectively). The planning method allows selecting the most suitable colonic segment, planning in advance the levels of feeding vessels intersection and forming a graft by subtotal colon mobilization. Adverse factors in relation to the mortality risk from respiratory complications and from other causes are the fact of graft necrosis development, the presence of long-existing cervical fistula in conditions of wound infection and the presence of bile reflux, stage III and IV of malignant tumors.