Abstract
Background
A challenge in esophageal reconstruction after esophagectomy is that the distance from the neck to the abdomen must be replaced with a long segment obtained from the gastrointestinal tract. The success or failure of the reconstruction depends on the blood flow to the reconstructed organ and the tension on the anastomotic site, both of which depend on the reconstruction distance. There are three possible esophageal reconstruction routes: posterior mediastinal, retrosternal, and subcutaneous. However, there is still no consensus as to which route is the shortest.
Methods
The length of each reconstruction route was retrospectively compared using measurements obtained during surgery, where the strategy was to pull up the gastric conduit through the shortest route. The proximal reference point was defined as the left inferior border of the cricoid cartilage and the distal reference point was defined as the superior border of the duodenum arising from the head of the pancreas.
Results
This study involved 112 Japanese patients with esophageal cancer (102 men, 10 women). The mean distances of the posterior mediastinal, retrosternal, and subcutaneous routes were 34.7 ± 2.37 cm, 32.4 ± 2.24 cm, and 36.3 ± 2.27 cm, respectively. The retrosternal route was significantly shorter than the other two routes (both p < 0.0001) and shorter by 2.31 cm on average than the posterior mediastinal route. The retrosternal route was longer than the posterior mediastinal route in only 5 patients, with a difference of less than 1 cm.
Conclusion
The retrosternal route was the shortest for esophageal reconstruction in living Japanese patients.
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References
Takeuchi H, Miyata H, Gotoh M, et al. A risk model for esophagectomy using data of 5334 patients included in a Japanese nationwide web-based database. Ann Surg. 2014;260:259–66.
Orringer MB, Sloan H. Substernal gastric bypass of the excluded thoracic esophagus for palliation of esophageal carcinoma. J Thorac Cardiovasc Surg. 1975;70:836–51.
Ngan SYK, Wong J. Length of different routes for esoophageal replacement. J Thorac Cardiovasc Surg. 1986;91:790–2.
Coral RP, Constant-Neto M, Silva IS, et al. Comparaison anatomical study of the anterior and posterior mediastinum as access routes after esopahgestomy. Dis Esophagus. 2003;16:236–8.
Chen H, Lu JJ, Zhou J, et al. Anterior versus posterior routes of reconstruction after esophagectomy: a comparative anatomic study. Ann Thorac Surg. 2009;87:400–4.
Hu H, Ye T, Tan D, et al. Is anterior mediastinum route a shorter choice for esophageal reconstruction? A comparative anatomic study. Eur J Cardio-Thorac Surg. 2011;40:1466–9.
Yang J, Xu C, Lian D, et al. Esophageal reconstruction: posterior mediastinal or retrosternal route. J Surg Res. 2016;201:364–9.
Wong I, Tong DKH, Tsang RKY, et al. Continuous intraoperative vagus nerve stimulation for monitoring of recurrent laryngeal nerve during minimally invasive esophagectomy. J Vis Surg. 2017;3:9. https://doi.org/10.21037/jovs.2016.12.11.
Kanemura T, Miyata H, Yamasaki M, et al. Usefulness of intraoperative nerve monitoring in esophageal cancer surgery in predicting recurrent laryngeal nerve palsy and its severity. Gen Thorac Cardiovasc Surg. 2019;67:1075–80.
Triantafyllou T, Olson MT, Theodorou D, et al. Enhanced recovery pathways vs standard care pathways in esophageal cancer surgery: systemic review and meta-analysis. Esophagus. 2020;17:100–12.
Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg. 1995;69:634–40.
van Lanschot JJB, van Blankenstein M, Oei HY, et al. Randomized comparison of prevertebral and retrosternal gastric tube reconstruction after resection of oesophageal carcinoma. Br J Surg. 1999;86:102–8.
Shu YS, Shun C, Shi WP, et al. Tubular stomach or whole stomach for esophagectomy through cervico-thoraco-abdominal approach: a comparative clinical study on anastomotic leakage. Ir J Med Sci. 2013;182:477–80.
Jansen SM, de Bruin DM, van Berge Henegouwen MI, et al. Optical techniques for perfusion monitoring of the gastric tube after esophagectomy: a review of technologies and thresholds. Dis Esophagus. 2018;31:1–11.
Nishikawa K, Fujita T, Yuda M, et al. Quantitative assessment of blood flow in the gastric conduit with thermal imaging for esophageal reconstruction. Ann Surg. 2020;271:1087–94.
Urschel JD, Urschel DM, Miller JD, et al. A meta-analysis of randomized controlled trials of route of reconstruction after esophagectomy for cancer. Am J Surg. 2001;182:470–5.
Chan ML, Hsieh CC, Wang CW, et al. Reconstruction after esophagectomy for esophageal cancer: retrosternal or posterior mediastinal route? J Chin Med Assoc. 2011;74:505–10.
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The study was approved by the institutional review board of the Kindai University Faculty of Medicine (2020-057). All procedures were conducted in accordance with the Declaration of Helsinki.
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Yasuda, T., Shiraishi, O., Kato, H. et al. A comparative study of the lengths of different reconstruction routes used after thoracic esophagectomy. Esophagus 18, 468–474 (2021). https://doi.org/10.1007/s10388-020-00805-x
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DOI: https://doi.org/10.1007/s10388-020-00805-x