Delayed Esophageal Reconstruction: Indications, Techniques, and Outcomes

Objective: The purpose of this study was to evaluate indications, techniques, and outcomes of patients who underwent delayed esophageal reconstruction. Methods: A retrospective chart review was performed for all esophagectomy patients who underwent delayed esophageal reconstruction from 2006 to 2020. Demographics, surgical indication, type of esophageal discontinuity procedure performed, duration between esophagectomy and reconstruction, type and technique of reconstruction performed, follow-up duration, change in body mass index, and overall outcome were assessed. Results: Fifteen patients (8 women, 53.3%) with a median age of 57.6 years (IQR 50.5-66.7 years) were included. Etiology necessitating foregut discontinuity included: delayed postoperative complications in 6 (40.0%), iatrogenic injury in 3 (20.0%), strangulated bowel in 3 (20.0%), trauma in 2 (13.3%), and esophageal cancer in 1 (6.7%). Median duration of esophageal discontinuity was 277 days (range 105-1045). Eleven patients (73%) underwent a substernal colon interposition; 2 (13%) substernal gastric advancement; and 2 (13%) small bowel advancement in the posterior mediastinum with jejunum via Roux-en-Y. Complications were noted in 7 (47%) patients. Median decrease in BMI was 4.7 (IQR 1.4-12.4). Overall, 11 (73.3%) patients had a good outcome, 3 (20.0%) patients had a fair outcome, and 1 poor outcome (6.7%). The median follow-up duration since reconstruction was 4.2 (IQR 2.8-5.4) years. Conclusion: Delayed esophageal reconstruction can be performed with acceptable outcomes with careful preparation and often require lengthy recoveries.