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Surgical outcomes of reconstruction using the gastric tube and free jejunum for cervical esophageal cancer: analysis using the National Clinical Database of Japan

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Abstract

Background

Cervical esophageal cancer accounts for a small proportion of all esophageal cancers. Therefore, studies examining this cancer include a small patient cohort. Most patients with cervical esophageal cancer undergo reconstruction using a gastric tube or free jejunum after esophagectomy. We examined the current status of postoperative morbidity and mortality of cervical esophageal cancer based on big data.

Methods

Based on the Japan National Clinical Database, 807 surgically treated patients with cervical esophageal cancer were enrolled between January 1, 2016, and December 31, 2019. Surgical outcomes were retrospectively reviewed for each reconstructed organ using gastric tubes and free jejunum.

Results

The incidence of postoperative complications related to reconstructed organs was higher in the gastric tube reconstruction (17.9%) than in the free jejunum (6.7%) for anastomotic leakage (p < 0.01), but not significantly different for reconstructed organ necrosis (0.4% and 0.3%, respectively). The incidence rates of overall morbidity, pneumonia, 30-day reoperation, tracheal necrosis, and 30-day mortality using these reconstruction methods were 64.7% and 59.7%, 16.7% and 11.1%, 9.3% and 11.4%, 2.2% and 1.6%, and 1.2% and 0.0%, respectively. Only pneumonia was more common in the gastric tube reconstruction group (p = 0.03), but was not significantly different for any other complication.

Conclusions

The incidence of overall morbidities and reoperation, especially anastomotic leakage after gastric tube reconstruction, suggested a necessity for further improvement. However, the incidence of fatal complications, such as tracheal necrosis or reconstructed organ necrosis, was low for both reconstruction methods, and the mortality rate was acceptable as a means of radical treatment.

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Data availability

Data supporting this study’s fndings are available from the corresponding author on a reasonable request.

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Acknowledgements

The authors sincerely thank all participants of the NCD project for their great efforts in data registration. We thank Shinya Hirakawa, PhD, for his efforts in data management as a subanalyzer. We also thank Takeshi Naito, MD, PhD, and Kinji Kamiya, MD, PhD, for providing appropriate advice as supervisors as well as the working members of the database committee of the Japanese Society of Gastroenterological Surgery and e Japan Esophageal Society. The authors wish to acknowledge Mr. Keita Shimoakasho of the Japanese Society of Gastroenterological Surgery and Ms. Hitomi Okamoto, Ms. Natsumi Yamamoto, and Mr. Nariyoshi Butsuda of the NCD, Japan, for their valuable assistance with administration and database information.

Funding

This study was funded by Takeda Pharmaceutical Company, National Clinical Database, Johnson and Johnson, Nipro, Intuitive Surgical, Fujifilm Corporation, Asahi Kasei Pharma Corporation, Ono Pharmaceutical, Otsuka Pharmaceutical, Covidien, Taiho Pharmaceutical, Chugai Pharmaceutical, Kaken Pharmaceutical, Yakult Honsha, Tsumura and Company, Sumitomo Foundation, EA Pharma Co., Ltd., Eisai, Kyowa Hakko Kirin, MEDICON INC, Teijin Pharma, Shionogi, Ethicon, Olympus, Bristol-Myers Squibb, AstraZeneca, MSD K.K., Smith and Nephew, ASKA Pharmaceutical, Miyarisan Pharmaceutical, Toray Industries, Daiichi-Sankyo and Nippon Kayaku.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan

    Yutaka Miyawaki, Hiroshi Sato & Shinichi Sakuramoto

  2. The Japan Esophageal Society, Tokyo, Japan

    Yutaka Miyawaki, Yasuaki Nakajima, Hiroshi Sato, Naoto Fujiwara, Kenro Kawada, Shinichi Sakuramoto, Hideaki Shimada & Yuichiro Doki

  3. Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan

    Hisateru Tachimori

  4. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Hisateru Tachimori & Hiroaki Miyata

  5. Department of Surgery, Edogawa Hospital, Tokyo, Japan

    Yasuaki Nakajima

  6. Department of Esophageal Surgery, Tokyo Medical and Dental University, Tokyo, Japan

    Naoto Fujiwara & Kenro Kawada

  7. Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan

    Hiroaki Miyata

  8. Department of Gastroenterological Surgery and Clinical Oncology, Graduate School of Medicine, Toho University, Tokyo, Japan

    Hideaki Shimada

  9. Database Committee, The Japan Esophageal Society, Tokyo, Japan

    Masayuki Watanabe

  10. Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Yoshihiro Kakeji

  11. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Yuko Kitagawa

Authors
  1. Yutaka Miyawaki
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  2. Hisateru Tachimori
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  3. Yasuaki Nakajima
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  4. Hiroshi Sato
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  5. Naoto Fujiwara
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  6. Kenro Kawada
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  7. Hiroaki Miyata
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  8. Shinichi Sakuramoto
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  9. Hideaki Shimada
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  11. Yoshihiro Kakeji
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  12. Yuichiro Doki
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  13. Yuko Kitagawa
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Corresponding author

Correspondence to Yutaka Miyawaki.

Ethics declarations

Ethical statement

All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and the Helsinki Declaration of 1964 and later versions. The study protocol was approved by the Japanese Society of Gastroenterological Surgery and the Institutional Review Board of Edogawa Hospital (approval number 2020-19). The institutional review board waived the need for informed consent due to the retrospective nature of the study.

Conflict of interest

Author H.T. belongs to an endowed course funded by Takeda Pharmaceutical Company Limited and belongs to a department that accepts financial support from National Clinical Database, Johnson & Johnson K.K., Nipro Corporation and Intuitive Surgical Sàrl. The author received a research grant from FUJIFILM Corporation. Author H.M. is affiliated with a social collaboration department supported by grants from National Clinical Database, Johnson & Johnson K.K., Nipro Co., and Intuitive Surgical Sàrl, Author Y.Ki. received grants or contracts from ASAHI KASEI PHARMA CORPORATION, ONO PHARMACEUTICAL CO., LTD., Otsuka Pharmaceutical Factory Inc., Nippon Covidien Inc., TAIHO PHARMACEUTICAL CO., LTD., CHUGAI PHARMACEUTICAL CO., LTD., KAKEN PHARMACEUTICAL CO., LTD., Yakult Honsha Co. Ltd., Otsuka Pharmaceutical Co., Ltd., TSUMURA & CO., Sumitomo Pharma Co., Ltd., EA Pharma Co., Ltd., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., MEDICON INC., Takeda Pharmaceutical Co., Ltd., and TEIJIN PHARMA LIMITED. Author Y.Ki also received lecture fees, etc. from CHUGAI PHARMACEUTICAL CO., LTD., TAIHO PHARMACEUTICAL CO., LTD., ASAHI KASEI PHARMA CORPORATION, Otsuka Pharmaceutical Factory Inc., SHIONOGI & CO., LTD., Nippon Covidien Inc., Ethicon, Inc., ONO PHARMACEUTICAL CO., LTD., Olympus Corporation, Bristol-Myers Squibb K.K., AstraZeneca K.K., MSD K.K., Smith & Nephew KK., KAKEN PHARMACEUTICAL CO.,LTD., ASKA Pharmaceutical Co., Ltd., MIYARISAN PHARMACEUTICAL CO. LTD., Toray Industries, Inc., DAIICHI SANKYO COMPANY, LIMITED, Chugai Foundation for Innovative Drug Discovery Science, Nippon Kayaku Co., Ltd., and EA Pharma Co., Ltd. Authors Y.M., Y.N., H.Sa., N.F., K.K., S.S., H.Sh., M.W., Y.Ka, and Y.D. declare that they have no conflict of interest.

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Miyawaki, Y., Tachimori, H., Nakajima, Y. et al. Surgical outcomes of reconstruction using the gastric tube and free jejunum for cervical esophageal cancer: analysis using the National Clinical Database of Japan. Esophagus 20, 427–434 (2023). https://doi.org/10.1007/s10388-023-00997-y

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