World Journal of Surgery

, Volume 41, Issue 3, pp 804–809 | Cite as

Impact of the Level of Anastomosis on Reflux Esophagitis Following Esophagectomy with Gastric Tube Reconstruction

  • Makoto SakaiEmail author
  • Makoto Sohda
  • Tatsuya Miyazaki
  • Tomonori Yoshida
  • Yuji Kumakura
  • Hiroaki Honjo
  • Keigo Hara
  • Takehiko Yokobori
  • Hiroyuki Kuwano
Original Scientific Report



Among patients who undergo gastric tube reconstruction after esophagectomy, it is generally accepted that the incidence of reflux esophagitis (RE) is significantly lower in patients with neck anastomosis than in those with intrathoracic anastomosis. However, the true impact of the level of anastomosis on RE currently remains unclear.


We examined 53 patients with thoracic esophageal cancer underwent radical esophagectomy with gastric tube reconstruction and neck anastomosis. The level of anastomosis was assessed by measuring the distance from the sternal notch to the stapled ring by computed tomography. The relative level of anastomosis was calculated by the distance from the sternal notch to the most caudal side of the stapled ring (mm)/height (cm).


The relative level of anastomosis in 30 (56.6%) patients showed <0, which indicated that anastomosis in these patients was located at a lower level than the sternal notch. The mean relative level of anastomosis was significantly lower in patients with RE (grade A to D) than in those without RE (grade N) (−0.062 vs. −0.012 mm/cm, respectively; p = 0.043). RE was more severe with a lower relative level of anastomosis (p for trends = 0.044).


The level of anastomosis in patients with gastric tube reconstruction following esophagectomy was associated with the incidence of RE. The displacement of anastomosis into the thoracic cavity was detected in approximately half of the patients with neck anastomosis. RE was more severe with a lower level of anastomosis, even in patients with neck anastomosis.


Pylorus Infection Gastric Tube Reflux Esophagitis Bile Reflux Sternal Notch 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Author’s contribution

Study conception and design: MS, acquisition of data: TY, YK, HH, KH, analysis and interpretation of data: MS, MS, TM, TY, drafting of manuscript: MS, critical revision: HK.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest associated with this manuscript.


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Copyright information

© Société Internationale de Chirurgie 2016

Authors and Affiliations

  • Makoto Sakai
    • 1
    Email author
  • Makoto Sohda
    • 1
  • Tatsuya Miyazaki
    • 1
  • Tomonori Yoshida
    • 1
  • Yuji Kumakura
    • 1
  • Hiroaki Honjo
    • 1
  • Keigo Hara
    • 1
  • Takehiko Yokobori
    • 2
  • Hiroyuki Kuwano
    • 1
  1. 1.Department of General Surgical Science, Graduate School of MedicineGunma UniversityMaebashiJapan
  2. 2.Department of Molecular Pharmacology and Oncology, Graduate School of MedicineGunma UniversityMaebashiJapan

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