A 64-years-old male patient was hospitalized in the Fourth Medical College of Hebei Medical University on October 6, 2016, due to eating problems that lasted for 1 month. The patient has a 10-year history of controlled hypertension and a 5-year history of coronary heart disease but no history of drug and food allergies. The results of electronic gastroscopy showed that the esophageal mucosa was not smooth, and iodine in different areas was visible at 32-34 cm and 2-4 points from the incisor. The pathological report suggested adenocarcinoma. On October 10, 2016, the patient underwent cardiac cancer resection with colon interposition and regional lymph nodes cleaning via two thoracoabdominal incisions (upper abdominal median incision and right posterolateral thoracotomy). The tumor was located in the lesser curvature of the cardia, about 2 x 1 x 0.1 cm3 in size, invading the mucosa. The operation method for this case was the same as that of case 1. After the tumor was removed, the distribution of the colon blood vessels was observed. No variant arteriovenous was detected. The middle colon artery was ligated, the ascending colon, transverse colon, and part of the descending colon were freed, and the oral side of the transverse colon was disconnected. Subsequently, the ascending and descending colon was anastomosed end-to-side; the distal stomach and transverse colon were anastomosed end-to-side. Both of them used the Circular stapler (CDH25A, ETHINCON, USA). At 5-cm distal to the anastomotic opening of the stomach and transverse colon, the colon was ligated with two non-absorbable mousse suture and with staplers (TX60B, ETHICON, USA). And the mesocolon was preserved. Then, the patient was turned over, the right chest was opened to free and remove the thoracic esophagus, the colon was lifted to the chest, and end-to-side anastomosis was performed with the esophagus using the Circular stapler (CDH23A, ETHINCON, USA) Also, systematic lymph node dissection is necessary. The transplanted colon had an abundant blood supply. All anastomoses were end-to-side without tension, and the length of the transplanted colon was appropriate. The operation duration was 150 min.
The patient recovered well after the operation. Digestive tract angiography on October 15, 2016, showed that the esophageal mucosa was regular, the tube wall was soft, and the lumen was not narrowed or expanded (Figures 1D-F). Passage through the esophagus-colon anastomosis and colon-stomach anastomosis was smooth, with no abnormal channel. A close follow-up confirmed the absence of dysphagia, emptying disorders, malodor, or significant weight loss. His appetite was recovering, with no diarrhea or abdominal distension and rare acid reflux and heartburn occurrences. The last follow-up on December 21, 2021, showed no disease progression, slightly increased weight, and satisfactory quality of life.