Systematic review of free jejunal flap for secondary esophageal reconstruction.

Introduction: Esophagus reconstruction could be complicated by leakage, stenosis or graft loss. Salvage surgery may be needed in case of failure of endoscopic treatment or large esophagus defect. Although free jejunal flap is admitted for salvage head and neck reconstruction, few reports assess the results of free jejunal interposition in salvage esophagus reconstruction. We undertook a systematic review whose primary aim is to investigate outcomes of secondary esophageal reconstruction with free jejunal flap in terms of mortality, complications and functional results.

Material and method: We conducted a systematic review of the literature according to the PRISMA 2020 statements searching PubMed and Scopus databases for articles assessing free jejunal flap for secondary reconstruction after failed esophagus reconstruction. References of included studies were also screened. Studies quality was assessed using the JBI Critical Appraisal tools.

Results: 562 studies were yielded through databases search and 328 studies were yielded through citations search. 18 articles were included in the systematic review corresponding to a total of 62 patients from 3 to 76 years old. All studies were level of evidence IV case reports or case series. We found that overall mortality was 3.2%, anastomotic fistula rate was 21%, anastomotic stricture rate was 4.8% and graft loss rate was 9.7% with survival of all jejunal regrafts. Solid oral intake was achieved in 93.0% of cases.

Conclusion: Jejunal free flap is a pertinent option for secondary esophageal reconstruction but remains a challenging surgery with high risk of complications that requires multidisciplinary team in large volume/tertiary care hospitals.