Abstract
Purpose
Perioperative nursing after esophageal reconstruction is demanding, and nonsupercharged cervical Roux-en-Y esophagojejunostomy shifts nursing surveillance away from microvascular patency toward the more gradual signs of marginal conduit hypoperfusion. Nursing-focused reports describing phase-specific surveillance, documentation, and escalation for this reconstruction are lacking. This study aimed to describe an institutional perioperative nursing pathway together with the clinical outcomes and nursing process indicators observed in patients undergoing this procedure.Design
This study adopted a single-center, retrospective descriptive case-series design.Methods
In this study, we reviewed 22 consecutive patients with esophageal cancer who underwent nonsupercharged cervical Roux-en-Y esophagojejunostomy between January 2021 and April 2025. Data were retrospectively abstracted from routinely maintained clinical and nursing records. An institutional perioperative nursing pathway combining routine esophageal perioperative care with procedure-specific surveillance of the cervical jejunal conduit was in use throughout the study period. No formal sample-size calculation was performed and no comparator group was available; therefore, clinical outcomes and nursing process indicators were summarized descriptively.Findings
The median operation time was 274.0 minutes (IQR 255.8-288.5), median mechanical ventilation time 18.0 hours (IQR 14.0-19.8), median intensive care unit stay 4.0 days (IQR 3.0-5.2), and median total hospital stay 12.0 days (IQR 8.8-14.0). Enteral nutrition was initiated at a median of postoperative day 5.0. The early mobilization target was documented in 86.4% (19/22) of patients by postoperative day 2, all patients ambulated by postoperative day 4, and respiratory exercises were recorded at a median of 4 sessions per day (IQR 3-5). Clavien-Dindo grade II or higher complications were recorded in 22.7% (5/22) of patients, anastomotic leakage in 18.2% (4/22, all endoscopically confirmed), and pulmonary complications in 4.5% (1/22). Perfusion warning events were documented in 31.8% (7/22) of patients; all were managed according to the predefined nursing escalation process and resolved or did not progress. No graft necrosis, re-exploration, or 30-day death occurred.Conclusions
This case series describes the implementation of a structured perioperative nursing pathway for nonsupercharged cervical Roux-en-Y esophagojejunostomy and the outcomes observed under it. Perfusion warning events and anastomotic complications were documented without graft necrosis or reoperation. These preliminary observational findings offer practical clinical insight but do not establish pathway effectiveness. Prospective multicenter studies are required to evaluate implementation fidelity, measurement reliability, clinical effectiveness, and generalizability.