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World J Gastrointest Surg. Mar 27, 2019; 11(3): 155-168
Published online Mar 27, 2019. doi: 10.4240/wjgs.v11.i3.155
Conduit necrosis following esophagectomy: An up-to-date literature review
Antonios Athanasiou, Mairead Hennessy, Eleftherios Spartalis, Benjamin H L Tan, Ewen A Griffiths
Antonios Athanasiou, Department of Upper GI, Bariatric and Minimally Invasive Surgery, St. James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, United Kingdom
Mairead Hennessy, Department of Anaesthesia, University Hospital of Waterford, Waterford X91 ER8E, Ireland
Eleftherios Spartalis, Laboratory of Experimental Surgery and Surgical Research, University of Athens, Medical School, Athens 11527, Greece
Benjamin H L Tan, Ewen A Griffiths, Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
Author contributions: Athanasiou A and Hennessy M contributed to study design, manuscript preparation and review; Griffiths EA contributed to critical manuscript review, critical revision; final manuscript approval; Spartalis E and Tan BHL contributed to critical manuscript review.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Antonios Athanasiou, MD, MSc, PhD, Academic Fellow, Academic Research, Research Fellow, Senior Postdoctoral Fellow, Surgeon, Department of Upper GI, Bariatric and Minimally Invasive Surgery, St. James’ University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett St., Leeds LS9 7TF, United Kingdom. antwnis_athanasiou@hotmail.com
Telephone: +44-775-2014764 Fax: +44-121-3715896
Received: February 13, 2019
Peer-review started: February 14, 2019
First decision: February 26, 2019
Revised: March 21, 2019
Accepted: March 24, 2019
Article in press: March 24, 2019
Published online: March 27, 2019
Processing time: 42 Days and 23.3 Hours
Abstract

Esophageal conduit ischaemia and necrosis is an uncommon but devastating complication of esophagectomy and remains one of the most challenging issues in surgical practice. The incidence, time interval to develop symptoms, and clinical presentation are highly variable with no predictable pattern. Evidence comes from case reports and case series rather than randomized controlled trials. We describe the issues surrounding conduit necrosis affecting the stomach, jejunum and colon as an esophageal replacement and the advantages, disadvantages and challenges of each type of reconstruction. Diagnosis is challenging for the most experienced surgeon. Upper gastrointestinal endoscopy and computed tomography thorax with both oral and intravenous contrast is the gold standard. Management, either conservative or interventional is also a difficult decision. Management options include conservative treatment and more aggressive treatments such as stent insertion, surgical debridement and repair of the esophagus using jejunum, colon or a musculocutaneous flap. In spite of recent advances in surgical techniques, there is no reliable strategy to manage esophageal conduit necrosis. Our review covers the pathophysiology and clinical significance of esophageal necrosis while highlighting current techniques of prevention, diagnosis and treatment of this life-threatening condition.

Keywords: Esophagectomy; Esophageal cancers; Esophagogastric anastomosis

Core tip: Esophageal conduit necrosis is an uncommon but devastating complication of esophagectomy and remains one of the most challenging issues in surgical practice. The purpose of this literature review is to provide the practicing surgeon with an up to date literature review on this complication and discuss the management of this rare condition. The incidence, time interval to develop symptoms, and clinical presentation are highly variable with no predictable pattern. Evidence comes from case reports and case series rather than randomized controlled trials. Our review details the pathophysiology, predisposing factors, clinical symptoms, diagnostic approach and we will highlight treatment options for the management of this life threatening condition.