P1.180. Retrospective RCT Study: Esophageal Cancer Surgical Reconstruction When the Gastric Tube Cannot Be Used - Jejunum vs. Colon

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer Gastric tube reconstruction is the first choice for reconstructive organs in esophageal cancer surgery. However, when the gastric tube cannot be used due to some reasons, jejunum or colon reconstruction become an option. When selecting the organ, a multifaceted perspective is required, considering factors such as the stability of blood flow, the safety of the anastomotic site, nutritional status, and long-term function. However, no clear conclusion has been reached regarding the superiority of small bowel reconstruction over colonic reconstruction. Nagasaki University transitioned to a departmental system in April 2025. Before this transition, two teams performed different reconstruction techniques, resulting in a randomized controlled trial (RCT) design. We retrospectively reviewed 31 cases of esophageal cancer patients who underwent jejunum reconstruction (Group J) or colon reconstruction (Group C) between April 2007 and December 2024. We compare the short-term postoperative outcomes of two groups and evaluate the respective advantages and disadvantages. There were no significant differences in patient background factors, including age, sex, history of gastrectomy, presence of concomitant gastric cancer, esophageal tumor location, cTNM factors, or cStage. However, the proportion of patients undergoing second-stage surgery was significantly higher in Group C. Regarding surgical outcomes, no significant differences were observed in operative time, blood loss, anastomosis site, thoracic/abdominal approach, or in the rate of simultaneous gastrectomy. Reconstruction was performed via a subcutaneous cervical anastomosis in all cases, with vascular anastomosis by the plastic surgery team performed concomitantly in all cases. In short-term postoperative outcomes, comparison of postoperative day 7 CRP levels between the two groups showed significantly lower values in group J (p=0.033). No significant differences were observed in Clavien-Dindo Grade 2 or higher complications, reoperation rates, infectious complications, pneumonia, anastomotic leakage, anastomotic stricture, abdominal complications, postoperative length of stay, or 1-year postoperative weight change rate. When the gastric tubes cannot be used for reconstruction during esophageal cancer surgery, jejunum or colon reconstruction should be considered. There is no significant difference in short-term postoperative outcomes between the two groups. However, the lower CRP levels observed in Group J compared to Group C on postoperative day 7 suggest a potentially less invasive approach. As more cases accumulate, organ options should be evaluated considering long-term quality of life and the presence of late complications.