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Objective: Many cancer patients have limited esophageal reconstruction options when the stomach is unuseable as a replacement conduit or when long segment discontinuity exists. Jejunum has been used as an alternative conduit, both as a pedicled or free flap interposition, however reports of this are usually limited to short segment repairs. Microvascular augmentation of a pedicled jejunal flap allows creation of a longer conduit, making it possible to replace the entire esophagus with jejunum. Few reports describe this technique in cancer patients. We report our initial experience with supercharged pedicled jejunum (SPJ) as an alternative conduit for total esophageal reconstruction.
Methods: Review of a prospectively collected departmental database was performed to identify those patients who underwent total esophageal reconstruction with SPJ. Data regarding their perioperative course and postoperative function were gathered from the database, review of hospital records, and patient interviews.
Results: Total esophageal reconstruction using SPJ was performed on 26 patients (ages 37 to 74 years) between March 2000 and April 2004. Twenty-four out of twenty-six patients were ultimately discharged with an intact SPJ flap, for an overall success rate of 92.3%. One patient suffered intraoperative flap loss due to technical difficulties harvesting the flap. One other flap loss occurred in the early post-operative period in a patient with multisystem organ failure. Cervical anastomotic leaks occurred in 20% (5/25) of patients. Two midconduit leaks occurred due to likely iatrogenic perforation, one requiring reoperation. One additional early reoperation was performed for cecal ischemia. There were no operative or 30-day mortalities.
Functional results were available in 95.4% (21/22) of SPJ patients who survived at least six months post reconstruction. Ninety-five percent (20/21) of patients were tolerating regular diet and 76.2% (16/21) did not require any supplemental alimentation. Ninety-five percent (20/21) of patients were free from reflux symptoms and 80.9% (17/21) had no dumping symptoms. Only two patients required dilation for anastomotic strictures. One patient required late reoperation for conduit redundancy.
Conclusions: Supercharged pedicled jejunum is a suitable alternative conduit for total esophageal replacement in cancer patients with otherwise limited reconstructive options. Functional outcomes are very good despite the severity of disease and technical challenges in this patient population.

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