Re-Resection and Deltopectoral Flap Reconstruction For Recurrent Anastomotic Esophageal Cancer

Re-Resection and Deltopectoral Flap Reconstruction For Recurrent Anastomotic Esophageal Cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Re-Resection and Deltopectoral Flap Reconstruction For Recurrent Anastomotic Esophageal Cancer Tzu-Yi Yang, Chih-Ying Li, Chung-Kan Tsao, Pin-Li Chou, Yin-Kai Chao, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4102774/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Anastomotic recurrence following esophagectomy is a rare occurrence. While complete resection yields better long-term outcomes, surgical management in this scenario poses challenges due to the impact of prior surgery and the fragile condition of patients. Here, we present an alternative surgical approach and reconstruction method to address this challenging scenario. Case presentation: Our patient, a 60-year-old man, developed anastomotic recurrence after neoadjuvant chemoradiotherapy and esophagectomy with gastric tube reconstruction via the retrosternal route. To tackle this issue, we employed an innovative surgical technique involving esophagogastrectomy via hemisternotomy, reconstruction using a deltopectoral fasciocutaneous local flap, and the establishment of a feeding jejunostomy. There were no major complications post-procedure, and the patient achieved good cancer control. Conclusions This approach not only offers significant technical advantages but also provides nutritional benefits. By adopting this novel approach, there is potential to enhance the current management of recurrent anastomotic esophageal cancer post-esophagectomy. Recurrent anastomotic esophageal cancer retrosternal route deltopectoral fasciocutaneous local flap Figures Figure 1 Figure 2 Background Esophagectomy is considered the primary curative treatment for locally advanced esophageal cancer. Previous studies have reported a significant variability in the rate of locoregional recurrence following this procedure, ranging from 9–19%.[ 1 , 2 ] However, the incidence of local recurrence at the anastomotic site has been generally found to be low, affecting less than 5% of operated patients.[ 2 ] Although complete resection can result in favorable long-term outcomes,[ 2 , 3 ] there is still no consensus on the optimal surgical approach for managing recurrent anastomotic lesions. Here, we present a case of recurrent anastomotic esophageal cancer that was effectively treated through re-resection and reconstruction using a deltopectoral fasciocutaneous local flap. Case presentation A 60-year-old man diagnosed with T1bN3M0 lower third thoracic esophageal squamous cell carcinoma underwent neoadjuvant chemoradiotherapy (nCRT) with a total radiation dose of 43.2 Gy delivered in 24 sessions of 1.8 Gy each. The chemotherapy treatment plan involved administering carboplatin on a weekly basis, with doses adjusted to achieve an area under the curve of 2 mg per milliliter per minute, along with paclitaxel at 50 mg/m 2 body surface area, for a period of six weeks. The nCRT regimen resulted in partial tumor response, and four months later, the patient underwent a McKeown minimally invasive esophagectomy with gastric tube reconstruction via the retrosternal route. Subsequent pathology revealed a pathological complete resection (ypT0N0M0), obviating the need for adjuvant therapy. However, after twenty months, the patient began experiencing dysphagia, leading to suspicion of tumor recurrence at the anastomotic site. A thorough cancer staging evaluation was conducted, including endoscopic biopsies (Fig. 1 A), endoscopic ultrasound, chest and abdomen computed tomography, and positron emission tomography (Fig. 1 B and C). The results confirmed the presence of recurrent squamous cell carcinoma at the esophagogastric anastomosis. Consequently, after one month, the patient underwent esophagogastrectomy and reconstruction. During the procedure, an upper hemi-sternotomy revealed a recurrent anastomotic tumor (Fig. 2 A), and a segmental defect of approximately 7 cm was observed after the esophagogastrectomy (Fig. 2 B). To address this issue, we opted to use a deltopectoral fasciocutaneous local flap with a propeller transposition design for the purpose of reconstruction (Fig. 2 C). To redirect post-operative salivary flow, we implemented a temporary esophagostomy at the superior edge of the tubed flap (Fig. 2 C). Additionally, we established a feeding jejunostomy to provide nutritional support. To close the donor site, we advanced the flap on the chest wall and applied a split-thickness skin graft to the shoulder area (Fig. 2 D). The patient experienced a fever episode along with local wound infection five days after surgery. However, with appropriate medical treatment, the condition improved. During subsequent follow-up esophagography, a mild leakage was detected, which necessitated the continuation of nutrition support through a feeding jejunostomy. After successfully managing these postoperative complications, the patient was discharged three weeks later. At six weeks post-surgery, he gradually started consuming water in small sips as part of the recovery process. Ten weeks after the operation, the patient underwent esophagostomy closure, taking into account the improvement in his dietary status. Subsequently, he received adjuvant chemotherapy with 5-fluorouracil and cisplatin. After eight months, the patient began experiencing progressive dysphagia due to an anastomotic stricture. However, these symptoms were effectively alleviated through endoscopic dilatation. A follow-up at 16 months revealed no evidence of tumor recurrence. Discussion and Conclusions Although rare, isolated local recurrence after curative esophagectomy for esophageal cancer can potentially be cured through complete resection. However, the surgical approaches for repeated reconstruction in cases of recurrent anastomotic esophageal cancer have been diverse. These include reanastomosis of the proximal esophagus and residual gastric conduit, as well as colon or jejunal interposition.[ 2 , 3 ] The surgical management technique utilized in our patient, consisting of re-operation after esophagectomy and gastric tube reconstruction via the retrosternal route, offers at least two significant advantages over previous methods. Firstly, locating the esophagogastric anastomosis becomes easier after upper hemi-sternotomy, reducing the risk of extensive pneumonolysis and potential lung injury caused by adhesions from previous radiotherapy and surgery. Additionally, consistent oxygenation can be achieved under two-lung ventilation throughout the procedure, particularly for individuals with compromised cardiopulmonary fitness following prior chemoradiotherapy. The most direct approach to reconstructing the esophagus after recurrent anastomotic esophageal cancer resection is through the anastomosis of the residual esophagus and gastric tube. However, this method may not always be possible when a long segmental defect is present. In such cases, an alternative conduit such as the colon or jejunum should be used for reconstruction. However, the harvest of a colonic or jejunal graft can be challenging due to prior abdominal surgery. To improve perioperative outcomes, the placement of a jejunostomy tube during esophagectomy has been shown to be beneficial.[ 4 ] However, the early introduction of enteral nutrition through feeding jejunostomy after colon or jejunal interposition may be limited due to multiple anastomoses distal to the jejunostomy wound. A local fasciocutaneous flap presents a viable option for reconstructing cervical esophageal or hypopharyngeal defects,[ 5 ] and is less surgically demanding than a free flap. Given the previous anastomosis at the retrosternal region, the utilization of a deltopectoral fasciocutaneous local flap proved to be a viable option for reconstructing the long segmental defect observed in our patient. Significantly, the implementation of a local flap technique enabled the prompt initiation of enteral nutrition via feeding jejunostomy. This achievement can be attributed to the reduced complexity of the abdominal surgical procedure. In light of these findings, we believe that embracing this surgical approach holds substantial promise for improving the existing treatment strategies for recurrent anastomotic esophageal cancer following esophagectomy. Declarations Acknowledgements Not applicable. Author contributions CK Tsao, YK Chao, and CH Chiu participated in the research design. TY Yang, CY Li, PL Chou, and CH Chiu participated in drafting the paper. All authors have read and approved the final manuscript. Funding The authors have no funding sources to disclose. Data availability The data will be shared on reasonable request to the corresponding author. Ethics approval and consent to participate The study was approved by the Institutional Review Board of Chang Gung Medical Foundation (Approval No. 202301669B0). Consent for publication Written informed consent has been obtained from the patient for publication of this paper. Competing interests The authors declare no competing interests. References Kunisaki C, Makino H, Takagawa R, Yamamoto N, Nagano Y, Fujii S, Kosaka T, Ono HA, Otsuka Y, Akiyama H, et al. Surgical outcomes in esophageal cancer patients with tumor recurrence after curative esophagectomy. J Gastrointest Surg. 2008;12:802–10. Carr RA, Harrington C, Vos E, Bains MS, Bott MJ, Isbell JM, Park BJ, Sihag S, Jones DR, Molena D. Treatment of Anastomotic Recurrence After Esophagectomy. Ann Thorac Surg. 2022;114:418–25. Schipper PH, Cassivi SD, Deschamps C, Rice DC, Nichols FC 3rd, Allen MS, Pairolero PC. Locally recurrent esophageal carcinoma: when is re-resection indicated? Ann Thorac Surg. 2005;80:1001–5. discussion 1005–1006. Watson M, Trufan S, Benbow JH, Gower NL, Hill J, Salo JC. Jejunostomy at the time of esophagectomy is associated with improved short-term perioperative outcomes: analysis of the NSQIP database. J Gastrointest Oncol. 2020;11:421–30. Kim Evans KF, Mardini S, Salgado CJ, Chen HC. Esophagus and hypopharyngeal reconstruction. Semin Plast Surg. 2010;24:219–26. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4102774","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":279777681,"identity":"cf938b74-8111-4946-8ee3-711aff6646dc","order_by":0,"name":"Tzu-Yi Yang","email":"","orcid":"","institution":"Linkou Chang Gung Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tzu-Yi","middleName":"","lastName":"Yang","suffix":""},{"id":279777682,"identity":"e97fd8a0-aae4-42a8-b8b6-56a6ffc73857","order_by":1,"name":"Chih-Ying Li","email":"","orcid":"","institution":"Linkou Chang Gung Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chih-Ying","middleName":"","lastName":"Li","suffix":""},{"id":279777683,"identity":"41d6aeaa-c177-45e8-bb0d-7c8e5a969716","order_by":2,"name":"Chung-Kan Tsao","email":"","orcid":"","institution":"Linkou Chang Gung Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chung-Kan","middleName":"","lastName":"Tsao","suffix":""},{"id":279777684,"identity":"5c3d595e-ee5e-47ac-9a99-a05defa5c712","order_by":3,"name":"Pin-Li Chou","email":"","orcid":"","institution":"Linkou Chang Gung Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Pin-Li","middleName":"","lastName":"Chou","suffix":""},{"id":279777685,"identity":"39961db6-2bb0-4d15-b6df-5db7ef71a56f","order_by":4,"name":"Yin-Kai Chao","email":"","orcid":"","institution":"Linkou Chang Gung Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yin-Kai","middleName":"","lastName":"Chao","suffix":""},{"id":279777686,"identity":"eb9545e7-9b02-495f-ad80-67a2f3051779","order_by":5,"name":"Chien-Hung Chiu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYBACAzBZIcHDxszYcOADkM3GTpSWMzZy/OzNBx/OAGlhJkYLY1uasWTPsWRjHhCPkBZz9rPHHvO2HU7ccCPHTNrm1zZ5PmYGxg8fc3BrsezJSzfmOQfVktt327CNmYFZcuY2PA47AFTJUwbT0nObEaiFjZkXn5bzb4Ba2KBaLHtu2xPWAlLJA/M+w4/biURoeZduOAcWyL0Nt5PbmBmb8fvlfO6xB29gUfnjz23b+e3NBz98xKOFgYGHjYkHxmZsA5MN+NSDtTD+gHP+EFA8CkbBKBgFIxIAAG6TVl3TymXjAAAAAElFTkSuQmCC","orcid":"","institution":"Linkou Chang Gung Memorial Hospital","correspondingAuthor":true,"prefix":"","firstName":"Chien-Hung","middleName":"","lastName":"Chiu","suffix":""}],"badges":[],"createdAt":"2024-03-14 17:59:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4102774/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4102774/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53008443,"identity":"14009dee-cd22-476e-9e68-9bd9f5c5a332","added_by":"auto","created_at":"2024-03-19 15:19:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":4041097,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePre-operative imaging assessment. \u003c/strong\u003e(A) An endoscopic examination revealed a protruding recurrent cancerous mass at the site of esophagogastric anastomosis; (B and C) PET images (sagittal and axial sections) identified an intensely hypermetabolic mass at the esophagogastric anastomosis located in the retrosternal region.\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4102774/v1/2a26249e5a62e66dc444a9e2.png"},{"id":53008441,"identity":"2e557d4f-e32d-4bf6-8242-5ba1d9d08da5","added_by":"auto","created_at":"2024-03-19 15:19:09","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":9034448,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDetailed surgical procedure\u003c/strong\u003e. (A) Incision made for the removal of the tumor (marked by arrowhead) and subsequent reconstruction; (B) A 7-cm segmental defect was observed between the residual portion of the esophagus (marked by arrowhead) and the gastric tube (marked by arrow); (C) A locally sourced deltopectoral fasciocutaneous flap, designed with propeller transposition, was used for the reconstruction of the segmental defect. Then a temporary esophagostomy of 1.5 cm (marked by arrowhead) was created at the superior edge of the flap; (D) Condition of the wound following the surgical procedure.\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4102774/v1/5d4074660b14e154a83b9213.png"},{"id":53316544,"identity":"26198bc0-11ce-4f13-961c-d6a3aa1146f6","added_by":"auto","created_at":"2024-03-23 19:07:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3828209,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4102774/v1/2896750e-18ba-4c2b-868a-496ddc405ad7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Re-Resection and Deltopectoral Flap Reconstruction For Recurrent Anastomotic Esophageal Cancer","fulltext":[{"header":"Background","content":"\u003cp\u003eEsophagectomy is considered the primary curative treatment for locally advanced esophageal cancer. Previous studies have reported a significant variability in the rate of locoregional recurrence following this procedure, ranging from 9\u0026ndash;19%.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] However, the incidence of local recurrence at the anastomotic site has been generally found to be low, affecting less than 5% of operated patients.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Although complete resection can result in favorable long-term outcomes,[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] there is still no consensus on the optimal surgical approach for managing recurrent anastomotic lesions. Here, we present a case of recurrent anastomotic esophageal cancer that was effectively treated through re-resection and reconstruction using a deltopectoral fasciocutaneous local flap.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 60-year-old man diagnosed with T1bN3M0 lower third thoracic esophageal squamous cell carcinoma underwent neoadjuvant chemoradiotherapy (nCRT) with a total radiation dose of 43.2 Gy delivered in 24 sessions of 1.8 Gy each. The chemotherapy treatment plan involved administering carboplatin on a weekly basis, with doses adjusted to achieve an area under the curve of 2 mg per milliliter per minute, along with paclitaxel at 50 mg/m\u003csup\u003e2\u003c/sup\u003e body surface area, for a period of six weeks. The nCRT regimen resulted in partial tumor response, and four months later, the patient underwent a McKeown minimally invasive esophagectomy with gastric tube reconstruction via the retrosternal route. Subsequent pathology revealed a pathological complete resection (ypT0N0M0), obviating the need for adjuvant therapy. However, after twenty months, the patient began experiencing dysphagia, leading to suspicion of tumor recurrence at the anastomotic site. A thorough cancer staging evaluation was conducted, including endoscopic biopsies (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA), endoscopic ultrasound, chest and abdomen computed tomography, and positron emission tomography (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB and C). The results confirmed the presence of recurrent squamous cell carcinoma at the esophagogastric anastomosis. Consequently, after one month, the patient underwent esophagogastrectomy and reconstruction. During the procedure, an upper hemi-sternotomy revealed a recurrent anastomotic tumor (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA), and a segmental defect of approximately 7 cm was observed after the esophagogastrectomy (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). To address this issue, we opted to use a deltopectoral fasciocutaneous local flap with a propeller transposition design for the purpose of reconstruction (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC). To redirect post-operative salivary flow, we implemented a temporary esophagostomy at the superior edge of the tubed flap (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC). Additionally, we established a feeding jejunostomy to provide nutritional support. To close the donor site, we advanced the flap on the chest wall and applied a split-thickness skin graft to the shoulder area (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eD). The patient experienced a fever episode along with local wound infection five days after surgery. However, with appropriate medical treatment, the condition improved. During subsequent follow-up esophagography, a mild leakage was detected, which necessitated the continuation of nutrition support through a feeding jejunostomy. After successfully managing these postoperative complications, the patient was discharged three weeks later. At six weeks post-surgery, he gradually started consuming water in small sips as part of the recovery process. Ten weeks after the operation, the patient underwent esophagostomy closure, taking into account the improvement in his dietary status. Subsequently, he received adjuvant chemotherapy with 5-fluorouracil and cisplatin. After eight months, the patient began experiencing progressive dysphagia due to an anastomotic stricture. However, these symptoms were effectively alleviated through endoscopic dilatation. A follow-up at 16 months revealed no evidence of tumor recurrence.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion and Conclusions","content":"\u003cp\u003eAlthough rare, isolated local recurrence after curative esophagectomy for esophageal cancer can potentially be cured through complete resection. However, the surgical approaches for repeated reconstruction in cases of recurrent anastomotic esophageal cancer have been diverse. These include reanastomosis of the proximal esophagus and residual gastric conduit, as well as colon or jejunal interposition.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] The surgical management technique utilized in our patient, consisting of re-operation after esophagectomy and gastric tube reconstruction via the retrosternal route, offers at least two significant advantages over previous methods. Firstly, locating the esophagogastric anastomosis becomes easier after upper hemi-sternotomy, reducing the risk of extensive pneumonolysis and potential lung injury caused by adhesions from previous radiotherapy and surgery. Additionally, consistent oxygenation can be achieved under two-lung ventilation throughout the procedure, particularly for individuals with compromised cardiopulmonary fitness following prior chemoradiotherapy. The most direct approach to reconstructing the esophagus after recurrent anastomotic esophageal cancer resection is through the anastomosis of the residual esophagus and gastric tube. However, this method may not always be possible when a long segmental defect is present. In such cases, an alternative conduit such as the colon or jejunum should be used for reconstruction. However, the harvest of a colonic or jejunal graft can be challenging due to prior abdominal surgery. To improve perioperative outcomes, the placement of a jejunostomy tube during esophagectomy has been shown to be beneficial.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] However, the early introduction of enteral nutrition through feeding jejunostomy after colon or jejunal interposition may be limited due to multiple anastomoses distal to the jejunostomy wound. A local fasciocutaneous flap presents a viable option for reconstructing cervical esophageal or hypopharyngeal defects,[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and is less surgically demanding than a free flap. Given the previous anastomosis at the retrosternal region, the utilization of a deltopectoral fasciocutaneous local flap proved to be a viable option for reconstructing the long segmental defect observed in our patient. Significantly, the implementation of a local flap technique enabled the prompt initiation of enteral nutrition via feeding jejunostomy. This achievement can be attributed to the reduced complexity of the abdominal surgical procedure. In light of these findings, we believe that embracing this surgical approach holds substantial promise for improving the existing treatment strategies for recurrent anastomotic esophageal cancer following esophagectomy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCK Tsao, YK Chao, and CH Chiu participated in the research design. TY Yang, CY Li, PL Chou, and CH Chiu participated in drafting the paper. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no funding sources to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data will be shared on reasonable request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Review Board of Chang Gung Medical Foundation (Approval No. 202301669B0).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent has been obtained from the patient for publication of this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKunisaki C, Makino H, Takagawa R, Yamamoto N, Nagano Y, Fujii S, Kosaka T, Ono HA, Otsuka Y, Akiyama H, et al. Surgical outcomes in esophageal cancer patients with tumor recurrence after curative esophagectomy. J Gastrointest Surg. 2008;12:802\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarr RA, Harrington C, Vos E, Bains MS, Bott MJ, Isbell JM, Park BJ, Sihag S, Jones DR, Molena D. Treatment of Anastomotic Recurrence After Esophagectomy. Ann Thorac Surg. 2022;114:418\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchipper PH, Cassivi SD, Deschamps C, Rice DC, Nichols FC 3rd, Allen MS, Pairolero PC. Locally recurrent esophageal carcinoma: when is re-resection indicated? Ann Thorac Surg. 2005;80:1001\u0026ndash;5. discussion 1005\u0026ndash;1006.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatson M, Trufan S, Benbow JH, Gower NL, Hill J, Salo JC. Jejunostomy at the time of esophagectomy is associated with improved short-term perioperative outcomes: analysis of the NSQIP database. J Gastrointest Oncol. 2020;11:421\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim Evans KF, Mardini S, Salgado CJ, Chen HC. Esophagus and hypopharyngeal reconstruction. Semin Plast Surg. 2010;24:219\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Recurrent anastomotic esophageal cancer, retrosternal route, deltopectoral fasciocutaneous local flap","lastPublishedDoi":"10.21203/rs.3.rs-4102774/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4102774/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAnastomotic recurrence following esophagectomy is a rare occurrence. While complete resection yields better long-term outcomes, surgical management in this scenario poses challenges due to the impact of prior surgery and the fragile condition of patients. Here, we present an alternative surgical approach and reconstruction method to address this challenging scenario.\u003c/p\u003e\u003ch2\u003eCase presentation:\u003c/h2\u003e \u003cp\u003eOur patient, a 60-year-old man, developed anastomotic recurrence after neoadjuvant chemoradiotherapy and esophagectomy with gastric tube reconstruction via the retrosternal route. To tackle this issue, we employed an innovative surgical technique involving esophagogastrectomy via hemisternotomy, reconstruction using a deltopectoral fasciocutaneous local flap, and the establishment of a feeding jejunostomy. There were no major complications post-procedure, and the patient achieved good cancer control.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis approach not only offers significant technical advantages but also provides nutritional benefits. By adopting this novel approach, there is potential to enhance the current management of recurrent anastomotic esophageal cancer post-esophagectomy.\u003c/p\u003e","manuscriptTitle":"Re-Resection and Deltopectoral Flap Reconstruction For Recurrent Anastomotic Esophageal Cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-19 15:17:21","doi":"10.21203/rs.3.rs-4102774/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a856f72d-a80e-416c-b62f-ee5e1a5d6a6f","owner":[],"postedDate":"March 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-23T03:07:55+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-19 15:17:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4102774","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4102774","identity":"rs-4102774","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}