Application of a Two-stage Operation for High-risk Gastrectomized Patients with Esophageal Cancer—Report of Two Cases—

Abstract

Background. Reconstruction following esophagectomy for gastrectomized patients with esophageal cancer is highly invasive and complicated that poses problem of adhesion of the organ for reconstruction. We have actively applied a two-stage operation for high risk patients with esophageal cancer. We recently applied the two-stage operation for two high-risk gastrectomized patients that ensured safe resection and reconstruction.
Cases. Patient 1 had synchronous esophageal cancer and hypopharyngeal cancer. Following total pharyngo-laryngo-esophagectomy, a free jejunal graft was transplanted, and the distal end of the jejunum was placed into the neck as jejunostomy during the 1^st operation, because vascular anastomoses would be difficult during the 2^nd operation. Reconstruction with right colon was performed at the 2^nd operation. Patient 2 who was an elderly had a past history of pancreatico-duodenectomy with declined cardiac function. During the 2^nd operation, the operative approach was limited just around the right colon used for reconstruction because tight adhesion was recognized in the upper abdomen. Both patients had an uncomplicated postoperative course.
Conclusion. The two-stage operation would lead to expand the indication of operation for high-risk patients with esophageal cancer.