Chinese expert consensus on the application of jejunal interposition for esophageal reconstruction in complex esophageal cancer surgery (2026 edition)_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Wenshu ¹ , ZHAO Lilan ¹ , LIN Zhaoxian ¹ , OU Debin ¹ , LI Zhigang ² , ZHU Chengchu ³ , CHEN Longqi ⁴ , LIU Shuoyan ⁵ , LI Xiangnan ⁶ , CHENG Chao ⁷ , ZHANG Ni ⁸ , XIE Songping ⁹ , GUO Xufeng ² , LI Xu ¹⁰ , MEI Xinyu ¹¹ , LENG Xuefeng ¹² , MA Jianqun ¹³ , HUANG Zhijun ¹⁴ , GENG Guojun ¹⁵ , ZHANG Lin ¹⁶ , WANG Hongyan ¹⁷ , ZHANG Yi ¹⁸ , WANG Weijie ¹⁹ , LIN Jiangbo ²⁰ , XIE Jinbiao ²¹ , GUAN Jun ²² , HE Rongqi ²³ , LIN Xing ¹ , TU Xiuhua ¹ ,  LI Yong ²⁴ ,  TAN Lijie ²⁵ ,  PAN Xiaojie ¹

1. Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou University, Fuzhou, 350001, P. R. China;
2. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China;
3. Department of Thoracic Surgery, Taizhou Enze Medical Center, Taizhou, 318000, Zhejiang, P. R. China;
4. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
5. Department of Thoracic Surgery, Fujian Cancer Hospital, Fuzhou, 350014, P. R. China;
6. Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, P. R. China;
7. Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, P. R. China;
8. Department of Thoracic Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, P. R. China;
9. Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, P. R. China;
10. Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, P. R. China;
11. Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, P. R. China;
12. Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, 610041, P. R. China;
13. Department of Thoracic Surgery, Heilongjiang Cancer Hospital, Harbin, 150081, P. R. China;
14. Department of Gastrointestinal and Esophageal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, P. R. China;
15. Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, Fujian, P. R. China;
16. Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, 250021, P. R. China;
17. Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, P. R. China;
18. Department of Thoracic Surgery, Zhangzhou Municipal Hospital, Zhangzhou, 363000, Fujian, P. R. China;
19. Department of Thoracic Surgery, Anyang Cancer Hospital, Anyang, 455000, Henan, P. R. China;
20. Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China;
21. Department of Thoracic Surgery, The Affiliated Hospital of Putian University, Putian, 351100, Fujian, P. R. China;
22. Department of Thoracic Surgery, Putian First Hospital, Putian, 351100, Fujian, P. R. China;
23. Department of Thoracic Surgery, Quanzhou First Hospital, Quanzhou, 362000, Fujian, P. R. China;
24. Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P. R. China;
25. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China;

Corresponding?author：

LI Yong, Email: liyongdoctor@126.com; TAN Lijie, Email: Tan.lijie@zs-hospital.sh.cn; PAN Xiaojie, Email: xjiepan@163.com

Keywords：

Esophageal neoplasms; jejunal esophageal replacement; pedicled jejunal interposition; supercharge; digestive tract reconstruction; expert consensus

DOI：

10.7507/1007-4848.202608016

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective Jejunal interposition is an important option for restoring gastrointestinal continuity in patients with complex esophageal cancer in whom the stomach is unavailable for reconstruction due to previous gastrectomy, tumor involvement, failed gastric conduit, or other constraints. Although the jejunum offers a caliber similar to the esophagus, a rich blood supply, and preserved peristaltic function, anatomical variations in mesenteric length and vascular arcades render long-segment and high-level reconstruction susceptible to excessive tension, mesenteric torsion, venous congestion, and inadequate distal perfusion. This consensus aims to provide standardized recommendations for the application of jejunal interposition in this specific patient population. Methods This consensus was developed in accordance with the WHO Handbook for Guideline Development and Chinese national guideline development standards, with reference to the Appraisal of Guidelines for Research & Evaluation Ⅱ(AGREE Ⅱ), Reporting Items for Practice Guidelines in Healthcare (RIGHT), and Scientific, Transparent and Applicable Rankings (STAR) checklists. The project was registered on the international practice guidelines registry platform (PREPARE-2026CN1384). The working group systematically searched Chinese and English evidence addressing 12 clinical questions. Evidence was graded using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2009 system, with structured appraisal of risk of bias, inconsistency, indirectness, and imprecision. Recommendations were formulated through two rounds of Delphi surveys and a face-to-face consensus meeting, with an agreement threshold of ≥75%. Results The consensus generated 12 recommendations covering indications, selection between jejunum and colon, preoperative assessment, surgical approach and reconstruction route, pedicled jejunal interposition (PJI), supercharged pedicled jejunal interposition (SPJ), indocyanine green (ICG) perfusion assessment, perioperative nutrition, management of anastomotic leakage, long-term follow-up, and special treatment scenarios. Given that the available direct evidence is predominantly derived from single-center retrospective cohorts and case series, recommendations extrapolated from general esophagectomy or other gastrointestinal surgical evidence are deliberately phrased with caution. Conclusion Jejunal interposition is a safe and effective approach for digestive tract reconstruction in patients with complex esophageal cancer in whom the stomach is unavailable. This consensus emphasizes that clinical decision-making should be individualized based on the patient's prior treatment history, reconstruction height, vascular anatomy, technical availability, and institutional experience in the Chinese context.

1.	中華人民共和國國家衛生健康委員會醫政醫管局. 食管癌診療指南(2022年版)[J]. 中華消化外科雜志, 2022, 21(10): 1247-1268.Bureau of Medical Administration, National Health Commission of the People's Republic of China. Esophageal cancer diagnosis and treatment guidelines (2022 edition)[J]. Chin J Dig Surg, 2022, 21(10): 1247-1268.
2.	Bakshi A, Sugarbaker DJ, Burt BM. Alternative conduits for esophageal replacement[J]. Ann Cardiothorac Surg, 2017, 6(2): 137-143.
3.	Butskiy O, Chang BA, Anderson DW, et al. 140-year history of pharyngoesophageal reconstruction[J]. J Laryngol Otol, 2024, 138(10): 1039-1047.
4.	Yudin SS. The surgical construction of 80 cases of artificial esophagus[J]. Surg Gynecol Obstet, 1944, 78: 561-583.
5.	Longmire WP, Ravitch MM. A new method for constructing an artificial esophagus[J]. Ann Surg, 1946, 123(5): 819-834.
6.	Seidenberg B, Rosenak SS, Hurwitt ES, et al. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment[J]. Ann Surg, 1959, 149(2): 162-171.
7.	Ascioti AJ, Hofstetter WL, Miller MJ, et al. Long-segment, supercharged, pedicled jejunal flap for total esophageal reconstruction[J]. J Thorac Cardiovasc Surg, 2005, 130(5): 1391-1398.
8.	Blackmon SH, Correa AM, Skoracki R, et al. Supercharged pedicled jejunal interposition for esophageal replacement: a 10-year experience[J]. Ann Thorac Surg, 2012, 94(4): 1104-1113.
9.	萬國泰, 孫躍昌. 帶蒂空腸重建血管移植代食管一例報告[J]. 第二軍醫大學學報, 1980, 3: 99-100.Wan GT, Sun YC. Reconstruction of the esophagus with pedicled jejunum and vascular anastomosis: a case report[J]. Acad J Second Mil Med Univ, 1980, 3: 99-100.
10.	程國良, 潘達德, 莊虔貞, 等. 吻合血管的帶蒂或游離空腸移植食管重建(附29例報告)[J]. 解放軍醫學雜志, 1992, 17(5): 337-340.Cheng GL, Pan DD, Zhuang QZ, et al. Esophageal reconstruction with vascularized pedicled or free jejunal transplantation: a report of 29 cases[J]. Med J Chin People's Liberation Army, 1992, 17(5): 337-340.
11.	Jiang S, Guo C, Zou B, et al. Comparison of outcomes of pedicled jejunal and colonic conduit for esophageal reconstruction[J]. BMC Surg, 2020, 20(1): 156.
12.	Doki Y, Okada K, Miyata H, et al. Long-term and short-term evaluation of esophageal reconstruction using the colon or the jejunum in esophageal cancer patients after gastrectomy[J]. Dis Esophagus, 2008, 21(2): 132-138.
13.	World Health Organization. WHO handbook for guideline development[M]. 2nd ed. Geneva: World Health Organization, 2014.
14.	蔣朱明, 詹思延, 賈曉巍, 等. 制訂/修訂《臨床診療指南》的基本方法及程序[J]. 中華醫學雜志, 2016, 96(4): 250-253.Jiang ZM, Zhan SY, Jia XW, et al. Basic methods and procedures for developing/revising clinical practice guidelines[J]. Natl Med J China, 2016, 96(4): 250-253.
15.	陳耀龍, 楊克虎, 王小欽, 等. 中國制訂/修訂臨床診療指南的指導原則(2022版)[J]. 中華醫學雜志, 2022, 102(10): 697-703.Chen YL, Yang KH, Wang XQ, et al. Guiding principles for developing/revising clinical practice guidelines in China (2022 edition)[J]. Natl Med J China, 2022, 102(10): 697-703.
16.	Brouwers MC, Kho ME, Browman GP, et al. AGREE Ⅱ: advancing guideline development, reporting and evaluation in health care[J]. J Clin Epidemiol, 2010, 63(12): 1308-1311.
17.	Chen Y, Yang K, Maru?ic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement[J]. Ann Intern Med, 2017, 166(2): 128-132.
18.	Yang N, Liu H, Zhao W, et al. Development of the Scientific, Transparent and Applicable Rankings (STAR) tool for clinical practice guidelines[J]. Chin Med J (Engl), 2023, 136(12): 1430-1438.
19.	Phillips B, Ball C, Sackett D, et al. Oxford Centre for Evidence-Based Medicine: levels of evidence (March 2009)[EB/OL]. (2009-03-01)[2026-08-12].
20.	Jun W, Wei W, Weibing W, et al. Clinical outcome of using gastric remnant or jejunum or colon conduit in surgery for esophageal carcinoma with previous gastrectomy[J]. J Surg Oncol, 2017, 115(6): 729-737.
21.	Nakanishi K, Daiko H, Kato F, et al. Efficacy of preserving the residual stomach in esophageal cancer patients with previous gastrectomy[J]. Gen Thorac Cardiovasc Surg, 2019, 67(5): 470-478.
22.	Jiang R, Wang Y, Xu J, et al. Reconstruction using the colon or jejunum in patients with synchronous advanced esophageal and gastric cancers: a retrospective study from a single institutional database[J]. BMC Surg, 2023, 23(1): 175.
23.	Brown J, Lewis WG, Foliaki A, et al. Colonic interposition after adult oesophagectomy: systematic review and meta-analysis of conduit choice and outcome[J]. J Gastrointest Surg, 2018, 22(6): 1104-1111.
24.	Hung PC, Chen HY, Tu YK, et al. A comparison of different types of esophageal reconstructions: a systematic review and network meta-analysis[J/OL]. J Clin Med, 2022, 11(17): 5025. DOI: 10.3390/jcm11175025.
25.	Yasuda T, Matsuda A, Hagiwara N, et al. Jejunal and colonic reconstruction after esophagectomy in difficult gastric conduit: a multicenter study and meta-analysis[J]. Surg Today, 2025, 56(1): 74-83.
26.	Maier A, Pinter H, Tomaselli F, et al. Retrosternal pedicled jejunum interposition: an alternative for reconstruction after total esophago-gastrectomy[J]. Eur J Cardiothorac Surg, 2002, 22(5): 661-665.
27.	Renard D, Molle G, Salmin JP. Systematic review of free jejunal flap for secondary esophageal reconstruction[J]. Ann Chir Plast Esthet, 2025, 70(5): 426-437.
28.	Zhao L, Ding Y, Zhang J, et al. Favorable outcomes with jejunal interposition without vascular anastomosis for esophagectomy in cancer patients: a single-center experience[J]. BMC Surg, 2025, 25(1): 302.
29.	Thompson K, Zendejas B, Svetanoff WJ, et al. Evolution, lessons learned, and contemporary outcomes of esophageal replacement with jejunum for children[J]. Surg, 2021, 170(1): 114-125.
30.	Obermannová R, Alsina M, Cervantes A, et al. Oesophageal cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up[J]. Ann Oncol, 2022, 33(10): 992-1004.
31.	National Institute for Health and Care Excellence. Oesophago-gastric cancer: assessment and management in adults[M]. London: National Institute for Health and Care Excellence (NICE), 2023.
32.	Hall LA, Jackson R, Soccorso G, et al. Assessment of jejunal interposition perfusion using indocyanine green[J/OL]. Photodiagnosis Photodyn Ther, 2023, 43: 103687. DOI: 10.1016/j.pdpdt.2023.103687.
33.	Lin Z, Sun S, Chen Y, et al. Indocyanine green fluorescence imaging improves the assessment of blood supply of interposition jejunum[J]. Surg Endosc, 2022, 36(9): 6456-6463.
34.	Mohan AT, Mahajan NN, Mardini S, et al. Outcomes of standardized protocols in supercharged pedicled jejunal esophageal reconstruction[J]. Ann Thorac Surg, 2023, 115(1): 210-219.
35.	Ryan éJ, Ryan OK, Corrigan N, et al. Indocyanine green fluorescence angiography for anastomotic perfusion assessment in colorectal surgery: a systematic review with meta-analysis, meta-regression, and trial sequential analyses[J]. Lancet Gastroenterol Hepatol, 2026, 11(5): 367-379.
36.	Iwata N, Koike M, Kamei Y, et al. Antethoracic pedicled jejunum reconstruction with the supercharge technique for esophageal cancer[J]. World J Surg, 2012, 36(11): 2622-2629.
37.	Boshier PR, Anderson O, Hanna GB. Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer[J]. Ann Surg, 2011, 254(6): 894-906.
38.	Li K, Lu S, Jiang L, et al. Long-term outcomes of intrathoracic versus cervical anastomosis after esophagectomy: a large-scale propensity score matching analysis[J]. J Thorac Cardiovasc Surg, 2025, 170(2): 391-404.
39.	Baker CR, Forshaw MJ, Gossage JA, et al. Long-term outcome and quality of life after supercharged jejunal interposition for oesophageal replacement[J]. Surgeon, 2015, 13(4): 187-193.
40.	Poh M, Selber JC, Skoracki R, et al. Technical challenges of total esophageal reconstruction using a supercharged jejunal flap[J]. Ann Surg, 2011, 253(6): 1122-1129.
41.	Chana JS, Chen HC, Sharma R, et al. Microsurgical reconstruction of the esophagus using supercharged pedicled jejunum flaps: special indications and pitfalls[J]. Plast Reconstr Surg, 2002, 110(3): 742-748.
42.	Barzin A, Norton JA, Whyte R, et al. Supercharged jejunum flap for total esophageal reconstruction: single-surgeon 3-year experience and outcomes analysis[J]. Plast Reconstr Surg, 2011, 127(1): 173-180.
43.	Tang H, Xue L, Hong J, et al. A method for early diagnosis and treatment of intrathoracic esophageal anastomotic leakage: prophylactic placement of a drainage tube adjacent to the anastomosis[J]. J Gastrointest Surg, 2012, 16(4): 722-727.
44.	Weijs TJ, Berkelmans GHK, Nieuwenhuijzen GAP, et al. Routes for early enteral nutrition after esophagectomy. A systematic review[J]. Clin Nutr, 2015, 34(1): 1-6.
45.	劉曉青, 高林春, 周東, 等. 早期腸內或腸外營養對食管癌術后療效影響的系統評價與Meta分析[J]. 中國胸心血管外科臨床雜志, 2020, 27(11): 1341-1347.Liu XQ, Gao LC, Zhou D, et al. Early enteral versus parenteral nutrition on postoperative outcomes of esophageal cancer: a systematic review and meta-analysis[J]. Chin J Clin Thorac Cardiovasc Surg, 2020, 27(11): 1341-1347.
46.	Chen W, Jiang X, Huang H, et al. Jejunal pouch reconstruction after total gastrectomy is associated with better short-term absorption capacity and quality of life in early-stage gastric cancer patients[J]. BMC Surg, 2018, 18(1): 72.
47.	Low DE, Allum W, De Manzoni G, et al. Guidelines for perioperative care in esophagectomy: Enhanced Recovery After Surgery (ERAS?) Society recommendations[J]. World J Surg, 2018, 43(2): 299-330.
48.	Markar SR, Karthikesalingam A, Low DE. Enhanced recovery pathways lead to an improvement in postoperative outcomes following esophagectomy: systematic review and pooled analysis[J]. Dis Esophagus, 2015, 28(5): 468-475.
49.	Markar SR, Naik R, Malietzis G, et al. Component analysis of enhanced recovery pathways for esophagectomy[J]. Dis Esophagus, 2017, 30(10): 1-10.
50.	Chen SJ, Shen CH, Chuang CY, et al. Impact of the enhanced recovery after surgery (ERAS) protocol on 3-year survival and outcomes following esophagectomy: a retrospective cohort study of 124 patients[J]. BMC Anesthesiol, 2025, 25(1): 256.
51.	Grimminger PP. Enhanced recovery after surgery (ERAS) for esophagectomy: a paradigm shift in perioperative care[J]. Ann Surg Oncol, 2024, 31(13): 8504-8505.
52.	Weimann A, Bezmarevic M, Braga M, et al. ESPEN guideline on clinical nutrition in surgery-update 2025[J]. Clin Nutr, 2025, 53: 222-261.
53.	Peng J, Cai J, Niu ZX, et al. Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta-analysis[J]. Dis Esophagus, 2016, 29(4): 333-341.
54.	Na KJ, Kang CH, Kim YR, et al. Comparison of clinical outcomes and postoperative nutritional status between early and late oral feeding after esophagectomy[J]. Ann Surg, 2025, 281(3): 388-394.
55.	Barbaro A, Eldredge TA, Shenfine J. Diagnosing anastomotic leak post-esophagectomy: a systematic review[J/OL]. Dis Esophagus, 2021, 34(2): doaa076. DOI: 10.1093/dote/doaa076.
56.	Stuart SK, Lemmens JMG, Nieuwenhuijzen GAP, et al. International Society for Diseases of the Esophagus consensus on the diagnosis and treatment of anastomotic leak after esophagectomy[J/OL]. Dis Esophagus, 2026, 39(1): doag006. DOI: 10.1093/dote/doag006.
57.	Mai Z, Xie J, Leng C, et al. An optimized postsurgery follow-up strategy for patients with esophageal cancer: a cohort study[J]. Int J Surg, 2024, 110(1): 332-341.
58.	Straatman J, Joosten PJM, Terwee CB, et al. Systematic review of patient-reported outcome measures in the surgical treatment of patients with esophageal cancer[J]. Dis Esophagus, 2016, 29(7): 760-772.
59.	Yamada E, Shirakawa Y, Yamatsuji T, et al. Jejunal interposition reconstruction with a stomach preserving esophagectomy improves postoperative weight loss and reflux symptoms for esophageal cancer patients[J]. J Surg Res, 2012, 178(2): 700-707.
60.	Sutcliffe RP, Forshaw MJ, Tandon R, et al. Anastomotic strictures and delayed gastric emptying after esophagectomy: incidence, risk factors and management[J]. Dis Esophagus, 2008, 21(8): 712-717.
61.	Cho YK, Shin JH, Kim BS, et al. Fluoroscopically guided balloon dilation of anastomotic strictures after total gastrectomy: long-term results[J]. AJR Am J Roentgenol, 2007, 188(3): 647-651.
62.	Lee HJ, Park W, Lee H, et al. Endoscopy-guided balloon dilation of benign anastomotic strictures after radical gastrectomy for gastric cancer[J]. Gut Liver, 2014, 8(4): 394-399.
63.	Won E, Ilson DH. Management of localized esophageal cancer in the older patient[J]. Oncologist, 2014, 19(4): 367-374.
64.	Mantziari S, Teixeira Farinha H, Bouygues V, et al. Esophageal cancer in elderly patients, current treatment options and outcomes: a systematic review and pooled analysis[J]. Cancers (Basel), 2021, 13(9): 2104.
65.	Sugita Y, Nakamura T, Sawada R, et al. Safety and feasibility of minimally invasive esophagectomy for elderly esophageal cancer patients[J/OL]. Dis Esophagus, 2021, 34(3): doaa083. DOI: 10.1093/dote/doaa083.
66.	Luan A, Hunter CL, Crowe CS, et al. Comparison of outcomes of total esophageal reconstruction with supercharged jejunal flap, colonic interposition, and gastric pull-up[J]. Ann Plast Surg, 2018, 80(5S): S274-S278.
67.	Marks JL, Hofstetter WL. Esophageal reconstruction with alternative conduits[J]. Surg Clin North Am, 2012, 92(5): 1287-1297.
68.	潘小杰, 趙力瀾, 陳文樹, 等. 空腸代食管術在食管外科中的現狀與展望[J]. 臨床外科雜志, 2021, 29(8): 788-792.Pan XJ, Zhao LL, Chen WS, et al. Current situation and prospects of jejunal conduit for esophageal reconstruction[J]. J Clin Surg, 2021, 29(8): 788-792.

1. 中華人民共和國國家衛生健康委員會醫政醫管局. 食管癌診療指南(2022年版)[J]. 中華消化外科雜志, 2022, 21(10): 1247-1268.Bureau of Medical Administration, National Health Commission of the People's Republic of China. Esophageal cancer diagnosis and treatment guidelines (2022 edition)[J]. Chin J Dig Surg, 2022, 21(10): 1247-1268.
2. Bakshi A, Sugarbaker DJ, Burt BM. Alternative conduits for esophageal replacement[J]. Ann Cardiothorac Surg, 2017, 6(2): 137-143.
3. Butskiy O, Chang BA, Anderson DW, et al. 140-year history of pharyngoesophageal reconstruction[J]. J Laryngol Otol, 2024, 138(10): 1039-1047.
4. Yudin SS. The surgical construction of 80 cases of artificial esophagus[J]. Surg Gynecol Obstet, 1944, 78: 561-583.
5. Longmire WP, Ravitch MM. A new method for constructing an artificial esophagus[J]. Ann Surg, 1946, 123(5): 819-834.
6. Seidenberg B, Rosenak SS, Hurwitt ES, et al. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment[J]. Ann Surg, 1959, 149(2): 162-171.
7. Ascioti AJ, Hofstetter WL, Miller MJ, et al. Long-segment, supercharged, pedicled jejunal flap for total esophageal reconstruction[J]. J Thorac Cardiovasc Surg, 2005, 130(5): 1391-1398.
8. Blackmon SH, Correa AM, Skoracki R, et al. Supercharged pedicled jejunal interposition for esophageal replacement: a 10-year experience[J]. Ann Thorac Surg, 2012, 94(4): 1104-1113.
9. 萬國泰, 孫躍昌. 帶蒂空腸重建血管移植代食管一例報告[J]. 第二軍醫大學學報, 1980, 3: 99-100.Wan GT, Sun YC. Reconstruction of the esophagus with pedicled jejunum and vascular anastomosis: a case report[J]. Acad J Second Mil Med Univ, 1980, 3: 99-100.
10. 程國良, 潘達德, 莊虔貞, 等. 吻合血管的帶蒂或游離空腸移植食管重建(附29例報告)[J]. 解放軍醫學雜志, 1992, 17(5): 337-340.Cheng GL, Pan DD, Zhuang QZ, et al. Esophageal reconstruction with vascularized pedicled or free jejunal transplantation: a report of 29 cases[J]. Med J Chin People's Liberation Army, 1992, 17(5): 337-340.
11. Jiang S, Guo C, Zou B, et al. Comparison of outcomes of pedicled jejunal and colonic conduit for esophageal reconstruction[J]. BMC Surg, 2020, 20(1): 156.
12. Doki Y, Okada K, Miyata H, et al. Long-term and short-term evaluation of esophageal reconstruction using the colon or the jejunum in esophageal cancer patients after gastrectomy[J]. Dis Esophagus, 2008, 21(2): 132-138.
13. World Health Organization. WHO handbook for guideline development[M]. 2nd ed. Geneva: World Health Organization, 2014.
14. 蔣朱明, 詹思延, 賈曉巍, 等. 制訂/修訂《臨床診療指南》的基本方法及程序[J]. 中華醫學雜志, 2016, 96(4): 250-253.Jiang ZM, Zhan SY, Jia XW, et al. Basic methods and procedures for developing/revising clinical practice guidelines[J]. Natl Med J China, 2016, 96(4): 250-253.
15. 陳耀龍, 楊克虎, 王小欽, 等. 中國制訂/修訂臨床診療指南的指導原則(2022版)[J]. 中華醫學雜志, 2022, 102(10): 697-703.Chen YL, Yang KH, Wang XQ, et al. Guiding principles for developing/revising clinical practice guidelines in China (2022 edition)[J]. Natl Med J China, 2022, 102(10): 697-703.
16. Brouwers MC, Kho ME, Browman GP, et al. AGREE Ⅱ: advancing guideline development, reporting and evaluation in health care[J]. J Clin Epidemiol, 2010, 63(12): 1308-1311.
17. Chen Y, Yang K, Maru?ic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement[J]. Ann Intern Med, 2017, 166(2): 128-132.
18. Yang N, Liu H, Zhao W, et al. Development of the Scientific, Transparent and Applicable Rankings (STAR) tool for clinical practice guidelines[J]. Chin Med J (Engl), 2023, 136(12): 1430-1438.
19. Phillips B, Ball C, Sackett D, et al. Oxford Centre for Evidence-Based Medicine: levels of evidence (March 2009)[EB/OL]. (2009-03-01)[2026-08-12].
20. Jun W, Wei W, Weibing W, et al. Clinical outcome of using gastric remnant or jejunum or colon conduit in surgery for esophageal carcinoma with previous gastrectomy[J]. J Surg Oncol, 2017, 115(6): 729-737.
21. Nakanishi K, Daiko H, Kato F, et al. Efficacy of preserving the residual stomach in esophageal cancer patients with previous gastrectomy[J]. Gen Thorac Cardiovasc Surg, 2019, 67(5): 470-478.
22. Jiang R, Wang Y, Xu J, et al. Reconstruction using the colon or jejunum in patients with synchronous advanced esophageal and gastric cancers: a retrospective study from a single institutional database[J]. BMC Surg, 2023, 23(1): 175.
23. Brown J, Lewis WG, Foliaki A, et al. Colonic interposition after adult oesophagectomy: systematic review and meta-analysis of conduit choice and outcome[J]. J Gastrointest Surg, 2018, 22(6): 1104-1111.
24. Hung PC, Chen HY, Tu YK, et al. A comparison of different types of esophageal reconstructions: a systematic review and network meta-analysis[J/OL]. J Clin Med, 2022, 11(17): 5025. DOI: 10.3390/jcm11175025.
25. Yasuda T, Matsuda A, Hagiwara N, et al. Jejunal and colonic reconstruction after esophagectomy in difficult gastric conduit: a multicenter study and meta-analysis[J]. Surg Today, 2025, 56(1): 74-83.
26. Maier A, Pinter H, Tomaselli F, et al. Retrosternal pedicled jejunum interposition: an alternative for reconstruction after total esophago-gastrectomy[J]. Eur J Cardiothorac Surg, 2002, 22(5): 661-665.
27. Renard D, Molle G, Salmin JP. Systematic review of free jejunal flap for secondary esophageal reconstruction[J]. Ann Chir Plast Esthet, 2025, 70(5): 426-437.
28. Zhao L, Ding Y, Zhang J, et al. Favorable outcomes with jejunal interposition without vascular anastomosis for esophagectomy in cancer patients: a single-center experience[J]. BMC Surg, 2025, 25(1): 302.
29. Thompson K, Zendejas B, Svetanoff WJ, et al. Evolution, lessons learned, and contemporary outcomes of esophageal replacement with jejunum for children[J]. Surg, 2021, 170(1): 114-125.
30. Obermannová R, Alsina M, Cervantes A, et al. Oesophageal cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up[J]. Ann Oncol, 2022, 33(10): 992-1004.
31. National Institute for Health and Care Excellence. Oesophago-gastric cancer: assessment and management in adults[M]. London: National Institute for Health and Care Excellence (NICE), 2023.
32. Hall LA, Jackson R, Soccorso G, et al. Assessment of jejunal interposition perfusion using indocyanine green[J/OL]. Photodiagnosis Photodyn Ther, 2023, 43: 103687. DOI: 10.1016/j.pdpdt.2023.103687.
33. Lin Z, Sun S, Chen Y, et al. Indocyanine green fluorescence imaging improves the assessment of blood supply of interposition jejunum[J]. Surg Endosc, 2022, 36(9): 6456-6463.
34. Mohan AT, Mahajan NN, Mardini S, et al. Outcomes of standardized protocols in supercharged pedicled jejunal esophageal reconstruction[J]. Ann Thorac Surg, 2023, 115(1): 210-219.
35. Ryan éJ, Ryan OK, Corrigan N, et al. Indocyanine green fluorescence angiography for anastomotic perfusion assessment in colorectal surgery: a systematic review with meta-analysis, meta-regression, and trial sequential analyses[J]. Lancet Gastroenterol Hepatol, 2026, 11(5): 367-379.
36. Iwata N, Koike M, Kamei Y, et al. Antethoracic pedicled jejunum reconstruction with the supercharge technique for esophageal cancer[J]. World J Surg, 2012, 36(11): 2622-2629.
37. Boshier PR, Anderson O, Hanna GB. Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer[J]. Ann Surg, 2011, 254(6): 894-906.
38. Li K, Lu S, Jiang L, et al. Long-term outcomes of intrathoracic versus cervical anastomosis after esophagectomy: a large-scale propensity score matching analysis[J]. J Thorac Cardiovasc Surg, 2025, 170(2): 391-404.
39. Baker CR, Forshaw MJ, Gossage JA, et al. Long-term outcome and quality of life after supercharged jejunal interposition for oesophageal replacement[J]. Surgeon, 2015, 13(4): 187-193.
40. Poh M, Selber JC, Skoracki R, et al. Technical challenges of total esophageal reconstruction using a supercharged jejunal flap[J]. Ann Surg, 2011, 253(6): 1122-1129.
41. Chana JS, Chen HC, Sharma R, et al. Microsurgical reconstruction of the esophagus using supercharged pedicled jejunum flaps: special indications and pitfalls[J]. Plast Reconstr Surg, 2002, 110(3): 742-748.
42. Barzin A, Norton JA, Whyte R, et al. Supercharged jejunum flap for total esophageal reconstruction: single-surgeon 3-year experience and outcomes analysis[J]. Plast Reconstr Surg, 2011, 127(1): 173-180.
43. Tang H, Xue L, Hong J, et al. A method for early diagnosis and treatment of intrathoracic esophageal anastomotic leakage: prophylactic placement of a drainage tube adjacent to the anastomosis[J]. J Gastrointest Surg, 2012, 16(4): 722-727.
44. Weijs TJ, Berkelmans GHK, Nieuwenhuijzen GAP, et al. Routes for early enteral nutrition after esophagectomy. A systematic review[J]. Clin Nutr, 2015, 34(1): 1-6.
45. 劉曉青, 高林春, 周東, 等. 早期腸內或腸外營養對食管癌術后療效影響的系統評價與Meta分析[J]. 中國胸心血管外科臨床雜志, 2020, 27(11): 1341-1347.Liu XQ, Gao LC, Zhou D, et al. Early enteral versus parenteral nutrition on postoperative outcomes of esophageal cancer: a systematic review and meta-analysis[J]. Chin J Clin Thorac Cardiovasc Surg, 2020, 27(11): 1341-1347.
46. Chen W, Jiang X, Huang H, et al. Jejunal pouch reconstruction after total gastrectomy is associated with better short-term absorption capacity and quality of life in early-stage gastric cancer patients[J]. BMC Surg, 2018, 18(1): 72.
47. Low DE, Allum W, De Manzoni G, et al. Guidelines for perioperative care in esophagectomy: Enhanced Recovery After Surgery (ERAS?) Society recommendations[J]. World J Surg, 2018, 43(2): 299-330.
48. Markar SR, Karthikesalingam A, Low DE. Enhanced recovery pathways lead to an improvement in postoperative outcomes following esophagectomy: systematic review and pooled analysis[J]. Dis Esophagus, 2015, 28(5): 468-475.
49. Markar SR, Naik R, Malietzis G, et al. Component analysis of enhanced recovery pathways for esophagectomy[J]. Dis Esophagus, 2017, 30(10): 1-10.
50. Chen SJ, Shen CH, Chuang CY, et al. Impact of the enhanced recovery after surgery (ERAS) protocol on 3-year survival and outcomes following esophagectomy: a retrospective cohort study of 124 patients[J]. BMC Anesthesiol, 2025, 25(1): 256.
51. Grimminger PP. Enhanced recovery after surgery (ERAS) for esophagectomy: a paradigm shift in perioperative care[J]. Ann Surg Oncol, 2024, 31(13): 8504-8505.
52. Weimann A, Bezmarevic M, Braga M, et al. ESPEN guideline on clinical nutrition in surgery-update 2025[J]. Clin Nutr, 2025, 53: 222-261.
53. Peng J, Cai J, Niu ZX, et al. Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta-analysis[J]. Dis Esophagus, 2016, 29(4): 333-341.
54. Na KJ, Kang CH, Kim YR, et al. Comparison of clinical outcomes and postoperative nutritional status between early and late oral feeding after esophagectomy[J]. Ann Surg, 2025, 281(3): 388-394.
55. Barbaro A, Eldredge TA, Shenfine J. Diagnosing anastomotic leak post-esophagectomy: a systematic review[J/OL]. Dis Esophagus, 2021, 34(2): doaa076. DOI: 10.1093/dote/doaa076.
56. Stuart SK, Lemmens JMG, Nieuwenhuijzen GAP, et al. International Society for Diseases of the Esophagus consensus on the diagnosis and treatment of anastomotic leak after esophagectomy[J/OL]. Dis Esophagus, 2026, 39(1): doag006. DOI: 10.1093/dote/doag006.
57. Mai Z, Xie J, Leng C, et al. An optimized postsurgery follow-up strategy for patients with esophageal cancer: a cohort study[J]. Int J Surg, 2024, 110(1): 332-341.
58. Straatman J, Joosten PJM, Terwee CB, et al. Systematic review of patient-reported outcome measures in the surgical treatment of patients with esophageal cancer[J]. Dis Esophagus, 2016, 29(7): 760-772.
59. Yamada E, Shirakawa Y, Yamatsuji T, et al. Jejunal interposition reconstruction with a stomach preserving esophagectomy improves postoperative weight loss and reflux symptoms for esophageal cancer patients[J]. J Surg Res, 2012, 178(2): 700-707.
60. Sutcliffe RP, Forshaw MJ, Tandon R, et al. Anastomotic strictures and delayed gastric emptying after esophagectomy: incidence, risk factors and management[J]. Dis Esophagus, 2008, 21(8): 712-717.
61. Cho YK, Shin JH, Kim BS, et al. Fluoroscopically guided balloon dilation of anastomotic strictures after total gastrectomy: long-term results[J]. AJR Am J Roentgenol, 2007, 188(3): 647-651.
62. Lee HJ, Park W, Lee H, et al. Endoscopy-guided balloon dilation of benign anastomotic strictures after radical gastrectomy for gastric cancer[J]. Gut Liver, 2014, 8(4): 394-399.
63. Won E, Ilson DH. Management of localized esophageal cancer in the older patient[J]. Oncologist, 2014, 19(4): 367-374.
64. Mantziari S, Teixeira Farinha H, Bouygues V, et al. Esophageal cancer in elderly patients, current treatment options and outcomes: a systematic review and pooled analysis[J]. Cancers (Basel), 2021, 13(9): 2104.
65. Sugita Y, Nakamura T, Sawada R, et al. Safety and feasibility of minimally invasive esophagectomy for elderly esophageal cancer patients[J/OL]. Dis Esophagus, 2021, 34(3): doaa083. DOI: 10.1093/dote/doaa083.
66. Luan A, Hunter CL, Crowe CS, et al. Comparison of outcomes of total esophageal reconstruction with supercharged jejunal flap, colonic interposition, and gastric pull-up[J]. Ann Plast Surg, 2018, 80(5S): S274-S278.
67. Marks JL, Hofstetter WL. Esophageal reconstruction with alternative conduits[J]. Surg Clin North Am, 2012, 92(5): 1287-1297.
68. 潘小杰, 趙力瀾, 陳文樹, 等. 空腸代食管術在食管外科中的現狀與展望[J]. 臨床外科雜志, 2021, 29(8): 788-792.Pan XJ, Zhao LL, Chen WS, et al. Current situation and prospects of jejunal conduit for esophageal reconstruction[J]. J Clin Surg, 2021, 29(8): 788-792.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesChinese expert consensus on the application of jejunal interposition for esophageal reconstruction in complex esophageal cancer surgery (2026 edition)

Abstract Full text Figures/Tables Video References Cited by

Format

Content