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

Wenshu CHEN; Lilan ZHAO; Zhaoxian LIN; Debin OU; Zhigang LI; Chengchu ZHU; Longqi CHEN; Shuoyan LIU; Xiangnan LI; Chao CHENG; Ni ZHANG; Songping XIE; Xufeng GUO; Xu LI; Xinyu MEI; Xuefeng LENG; Jianqun MA; Zhijun HUANG; Guojun GENG; Lin ZHANG; Hongyan WANG; Yi ZHANG; Weijie WANG; Jiangbo LIN; Jinbiao XIE; Jun GUAN; Rongqi HE; Xing LIN; Xiuhua TU; Yong LI; Lijie TAN; Xiaojie PAN

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

VernacularTitle:复杂食管癌外科治疗中空肠代食管术应用的中国专家共识（2026版）
Author: Wenshu CHEN ¹ ; Lilan ZHAO ¹ ; Zhaoxian LIN ¹ ; Debin OU ¹ ; Zhigang LI ² ; Chengchu ZHU ³ ; Longqi CHEN ⁴ ; Shuoyan LIU ⁵ ; Xiangnan LI ⁶ ; Chao CHENG ⁷ ; Ni ZHANG ⁸ ; Songping XIE ⁹ ; Xufeng GUO ² ; Xu LI ¹⁰ ; Xinyu MEI ¹¹ ; Xuefeng LENG ¹² ; Jianqun MA ¹³ ; Zhijun HUANG ¹⁴ ; Guojun GENG ¹⁵ ; Lin ZHANG ¹⁶ ; Hongyan WANG ¹⁷ ; Yi ZHANG ¹⁸ ; Weijie WANG ¹⁹ ; Jiangbo LIN ²⁰ ; Jinbiao XIE ²¹ ; Jun GUAN ²² ; Rongqi HE ²³ ; Xing LIN ¹ ; Xiuhua TU ¹ ; Yong LI ²⁴ ; Lijie TAN ²⁵ ; Xiaojie PAN
Author Information

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
Publication Type:Journal Article
Keywords: Esophageal neoplasms; jejunal esophageal replacement; pedicled jejunal interposition; supercharge; digestive tract reconstruction; expert consensus
From: Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2026;33(10):1527-1543
CountryChina
Language:Chinese
Abstract: 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.