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Efficacy and Postoperative Outcomes of Laparoscopic Retrosternal Route Creation for the Gastric Conduit: Propensity Score–Matched Comparison to Posterior Mediastinal Reconstruction

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Retrosternal reconstruction has lower risks for severe postoperative morbidities, such as gastro-tracheal fistula or esophageal hiatal hernia. We have previously reported the laparoscopic retrosternal route creation (LRRC) method, but its safety and efficacy remain unclear.

Methods

In total, 374 patients with esophageal carcinoma who underwent minimally invasive McKeown esophagectomy in the prone position between 2010 and 2021 were retrospectively reviewed. We performed a propensity score–matched analysis with the simple, nearest-neighbor method and no calipers to compare postoperative outcomes and reconstructed gastric conduit functionality between patients who underwent LRRC and counterparts who underwent posterior mediastinal reconstruction.

Results

After matching, 62 patients were included in the laparoscopic retrosternal group (LR group) or posterior mediastinal group (PM group). No significant differences were observed between the groups, apart from the number of robot-assisted surgeries, the extent of lymph node dissection, and the method of cervical anastomosis. There were no significant differences in the incidence of Clavien–Dindo grade ≥ 2 complications. Gastro-tracheal fistula (n = 1) and esophageal hiatal hernia (n = 2) occurred in the PM group but not in the LR group. There were no differences in the incidence of pulmonary embolism between the groups (5% vs. 5%). The postoperative anastomotic stenosis rate was similar (16% vs. 27%, p = 0.192). Endoscopic findings of reflux esophagitis (modified Los Angeles classification ≥ M) at 1 year after surgery were significantly better in the LR group (p = 0.037).

Conclusions

LRRC for gastric conduit reconstruction is safe and valuable. It is associated with good reconstructed gastric conduit function.

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Chuo-ku, Kobe, Hyogo, Japan

    Manabu Horikawa MD, Taro Oshikiri MD, Takashi Kato MD, Ryuichiro Sawada MD, Hitoshi Harada MD, Naoki Urakawa MD, Hironobu Goto MD, Hiroshi Hasegawa MD, Shingo Kanaji MD, Kimihiro Yamashita MD & Yoshihiro Kakeji MD

  2. Division of Minimally Invasive Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Chuo-ku, Kobe, Hyogo, Japan

    Takeru Matsuda MD

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  1. Manabu Horikawa MD
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Correspondence to Taro Oshikiri MD.

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Manabu Horikawa, Taro Oshikiri, Takashi Kato, Ryuichiro Sawada, Hitoshi Harada, Naoki Urakawa, Hironobu Goto, Hiroshi Hasegawa, Shingo Kanaji, Kimihiro Yamashita, Takeru Matsuda, and Yoshihiro Kakeji have no conflicts of interest or financial ties to disclose.

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Horikawa, M., Oshikiri, T., Kato, T. et al. Efficacy and Postoperative Outcomes of Laparoscopic Retrosternal Route Creation for the Gastric Conduit: Propensity Score–Matched Comparison to Posterior Mediastinal Reconstruction. Ann Surg Oncol 30, 4044–4053 (2023). https://doi.org/10.1245/s10434-023-13345-2

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