surgery for lower third lesions
Last reviewed 01/2018
Carcinoma of the lower third of the oesophagus requires a partial oesophago-gastrectomy via a thoraco-abdominal approach extending onto the abdomen. Before anastomosis, removal of the lesion and up to three-fifths of the stomach may be required.
Prior gastric surgery may result in too little stomach being available for this technique. Hence, a Roux-en-Y loop anastomosis of the jejunum to the oesophagus may be required:
- the length of diseased oesophagus and stomach remnant are removed
- the distal jejunum is drawn up and sutured side-on to the oesophageal remnant
- the proximal jejunum is anastomosed to the distal jejunum at a distance from the new oesophago-jejunal junction - this prevents biliary and pancreatic juice reflux