TOTAL RESECTION OF THE ESOPHAGUS

AND ESOPHAGEAL RECONSTRUCTION

WITH TUBULARIZED STOMACH THROUGHT
TRIPLE APPROACH MC KEOWN WITH
SEMI – MECHANICAL CERVICAL
ANASTOMOSIS TYPE ORRINGER.

Author : Popa Mihail Ioan

Co – author : Mocanu Carmen – Ioana

Coordinator : Asist. Univ. Dr. Alin Demetrian

 Esophageal cancer
• Worldwide esophageal cancer is increasing.
• The prognosis remains reserved despite the aggressive surgical treatment
integrated into a multimodal algorithm.
• Is found more frequently in men, the average age of occurrence is
approximately 60 years old.
 Case report

• Patient age 69 years old, smoker, alcoholic.

• Reasons for hospitalization : dysphagia for solid food
• weight loss
• loss of appetite
• physical asthenia
• Personal history insignificant.
Barium X-ray
Barium X-ray
Esophagoplasty – possible substitutes
for the esophagus

• Stomach
• Jejunum
• Descending colon
• Ascending Colon
• Rarely : free grafts of the jejunum, stomach,
cutaneous flap,musculocutaneous or external by-pass with
silicone prosthesis.
 Stomach as esophagus substitute

The stomach is the first choice for reconstruction, due to the multiple
advantages.
The stomach was mobilized by sacrificing the left arterial sources
(short gastric arteries and left gastric artery), preserving the right gastroepiploic
artery as the main arterial source
 Route Choice For Reconstruction

• posterior mediastinum
• retrosternal
• presternal
• transpleural
• endoesophageal
 Route Choice For Reconstruction

Retrosternal path
Advantages :
• easy to achieve.
• useful when esophageal bed is unusable.

Disadvantages :
• is a long route.
• predisposes to angulation, strangulation, affecting the substitute
vascularisation.
• unusable at the cardiac surgery patients or predisposed to such
interventions.
Triple approach technique – Mc Keown
 Triple approach technique – Mc Keown

Because the frequent intrathoracic anastomotic dehiscence,

Mc Keown(1972) introduces the triple approach technique(abdominal,
right thoracic and cervical) placing the anastomosis in the cervical region and
thereby reducing the postoperative complications.
 Histopathological Result
oSquamous cell carcinoma T3N0M0

oCeliac ganglion
oHepatic artery ganglion
oCeliac trunk ganglion
- without metastases
Postoperative after three weeks
Bronchoscopy control after six months
 After Bronchoscopy

• Mediastinum radiotherapy
• Death by quick alteration status at 2 weeks after
initiation of radiotherapy
 Conclusions

•. Esophageal cancer surgery represents a challenge both the complexity of the

surgery and the complications that may be encountered.

•For well-selected cases, good results can be obtained after radical interventions.

•One of the major goals of these types of interventions is the possibility of

resuming a normal diet for a better quality of life.
We are good for nothing,
but we are ready for
anything!
Thank you!