Jejunal interposition reconstruction with a stomach preserving esophagectomy improves postoperative weight loss and reflux symptoms for esophageal cancer patients Eiji Yamada, MD, a Yasuhiro Shirakawa, MD, PhD, a Tomoki Yamatsuji, MD, PhD, b Leon Sakuma, BA, c Munenori Takaoka, MD, PhD, b Takako Yamada, MD, PhD, b Kazuhiro Noma, MD, PhD, a Kazufumi Sakurama, MD, PhD, a Yasuhiro Fujiwara, MD, a Shunsuke Tanabe, MD, PhD, a Takeshi Nagasaka, MD, PhD, a Toshiyoshi Fujiwara, MD, PhD, a and Yoshio Naomoto, MD, PhD b, * a Department of Gastroenterological Surgery, Transplant, and Surgical Oncology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan b Department of General Surgery, Kawasaki Medical School, Okayama, Japan c Department of Universal Design, Kawasaki University of Medical Welfare, Kurashiki, Japan article info Article history: Received 3 February 2012 Received in revised form 7 June 2012 Accepted 20 July 2012 Available online 9 August 2012 Keywords: Esophageal cancer Jejunal interposition reconstruction Stomach preserving esophagectomy Postoperative QOL Reflux esophagitis abstract Background: Conventional reconstruction after an esophagectomy uses a gastric tube, which commonly causes several postoperative complaints such as gastric acid reflux in long-term survival cases. Intestinal interposition between the remnant esophagus and the stomach is an option to reduce complaints, and in this study, the advantages of jejunal interposition reconstruction with a stomach preserving esophagectomy (SPE) were assessed. Materials and methods: Eleven cases of jejunal interposition with an SPE and 16 cases with gastric tube reconstruction as a control were subject to a comparison of operation time, amount of bleeding, postoperative quality of life, and endoscopic findings. Results: The SPE group had a longer operation time (SPE: 560  121 min, control 414  83 min, P ¼ 0.038), whereas there was no significant difference in blood loss. Postoperative weight loss was significantly recovered in the SPE group (SPE versus control ¼ 94.0  5.4% versus 87.5  4.7% at 3 mo, P ¼ 0.017; 97.2  7.5% versus 85.0  5.2% at 6 mo, P ¼ 0.010), and there was a significant decrease in the occurrence of reflux symptoms such as heartburn, odynophagia, and cough when jejunal interposition with an SPE was done. Furthermore, reflux esophagitis and Barrett’s epithelium were found in six out of 12 cases (50%) of the control group by postoperative endoscopy, while no cases in the SPE group had either condition (P < 0.01). Conclusions: This reconstruction method is a promising option to improve postoperative quality of life, mainly due to the long-term elimination of reflux esophagitis, which assists in the recovery of postoperative weight loss. ª 2012 Elsevier Inc. All rights reserved. * Corresponding author. Department of General Surgery, Kawasaki Medical School Kawasaki Hospital, 2-1-80, Nakasange, Kita-ku, Okayama 700-8505, Japan. Tel.: þ81 86 225 2111; fax: þ81 86 232 8343. E-mail address: ynaomoto@med.kawasaki-m.ac.jp (Y. Naomoto). Available online at www.sciencedirect.com journal homepage: www.JournalofSurgicalResearch.com journal of surgical research 178 (2012) 700 e707 0022-4804/$ e see front matter ª 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2012.07.057