Laparoscopic creation of a retrosternal route for gastric conduit reconstruction

Horikawa, Manabu; Oshikiri, Taro; Takiguchi, Gosuke; Urakawa, Naoki; Hasegawa, Hiroshi; Yamamoto, Masashi; Kanaji, Shingo; Matsuda, Yoshiko; Yamashita, Kimihiro; Matsuda, Takeru; Suzuki, Satoshi; Kakeji, Yoshihiro

doi:10.1007/s00464-021-08745-y

Cited by 7 publications

(6 citation statements)

References 14 publications

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“…Cervical anastomotic leakage was one of the most common complications after MIE with a rate of up to 35% [26]. While some studies had shown that the PM route was associated with a lower occurrence of anastomotic leakage compared to the ST route [15][16][17][18], the other revealed no difference [11,19]. In our study, no gastric conduit necrosis was observed.…”

Section: Discussionmentioning

confidence: 41%

“…Moreover, reconstruction through the ST route might help avoid some severe complications such as airway-gastric conduit stula [10], hiatal and para-conduit hernia [11,12], and it might reduce incidences of gastroesophageal re ux [13], and pulmonary complications, particularly pneumonia compared with the PM route [14]. Meanwhile some prior studies showed a lower anastomotic leakage rate using PM route [15][16][17][18], the others revealed similar rates of anastomotic leakage between the two groups [11,19]. Two meta-analyses conducted on this issue showed no difference in postoperative outcomes for the two routes of reconstruction [8,20].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of substernal and posterior mediastinal route of reconstruction after minimally invasive esophagectomy for esophageal cancer

Dat,

Thong,

Nguyen

et al. 2023

Preprint

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Background Substernal (ST) and posterior mediastinal (PM) routes are the two most common for reconstruction after esophagectomy with cervical anastomosis. Recent evidence showed similar outcomes between the routes; thus, the superior choice remained controversial. This study aimed to compare the short-term outcomes of the ST to the PM route for reconstruction after esophagectomy for esophageal cancer (EC). Method This retrospective cohort study included 132 patients who underwent McKeown minimally invasive esophagectomy (MIE) with gastric conduit for EC between March 2015 and December 2022. Among these, eighty-nine and forty-three patients received the ST route and PM route for reconstruction, respectively. Short-term outcomes including operative characteristics, postoperative morbidity, and mortality were evaluated. Result There was no conversion from ST to PM route. The ST group had longer operating time (375 mins vs. 341 mins). Oral feeding initiation, postoperative hospital stays, and overall complication rates were comparable in the two groups. The rate and severity of anastomotic leakage were similar between the groups. The ST group had a significantly lower incidence of postoperative ICU admission and pneumonia compared to the PM group (5.6% vs. 16.3% and 19.1% vs. 37.2%, respectively). Azygos vein bleeding, obstruction at feeding jejunostomy site, and conduit–trachea fistula were severe complications that only occurred in PM route. Conclusion ST route was superior to PM route in term of postoperative ICU admission and pneumonia. This route may prevent severe complications that only occur in PM route. ST route can be favorable option for reconstruction after McKeown MIE for EC.

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Section: Discussionmentioning

confidence: 41%

Section: Introductionmentioning

confidence: 99%

Comparison of substernal and posterior mediastinal route of reconstruction after minimally invasive esophagectomy for esophageal cancer

Dat,

Thong,

Nguyen

et al. 2023

Preprint

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“…The retrosternal route is an alternative surgical approach to avoid the effects of irradiation on the gastric conduit in the adjuvant radiotherapy process and decrease the distance of the gastric conduit accompanying the airway [ 20 , 21 ]. However, the creation of the retrosternal tunnel may increase surgical trauma.…”

Section: Discussionmentioning

confidence: 99%

A approach of gastric conduit via the anterior of pulmonary hilum route during minimally invasive McKeown esophagectomy

Yan,

Xu,

Guo

et al. 2024

J Cardiothorac Surg

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Background The gastric conduit is the most commonly used replacement organ for reconstruction after minimally invasive McKeown esophagectomy. Although the optimal route of gastric conduit remains controversial, the posterior mediastinal route is physiologically preferable but is not without disadvantages. Here, we report the safety and efficacy of a method of gastric conduit reconstruction via the anterior of the pulmonary hilum route. Methods We have used the anterior of the pulmonary hilum route since 2021. This procedure involves pulling the gastric conduit up through a substernal tunnel between the right thoracic cavity and the abdominal cavity and passing it into the neck via the anterior of the pulmonary hilum route. In this retrospective study, we compared the clinical outcomes between 20 patients who underwent this procedure and 20 patients who underwent the posterior mediastinal route from 2021 to 2022. Results No mortality was reported in either group. No significant differences were observed between the two groups in duration of surgery, blood loss, incidence of postoperative complications, and postoperative hospital stay. As a result of the anterior of the pulmonary hilum route, the primary tumor bed and lymph node drainage area were effectively bypassed, which facilitates postoperative adjuvant radiotherapy or chemoradiotherapy. The distance of the gastric conduit accompanying the airway was significantly shorter in the anterior of the pulmonary hilum route group. Conclusions Our method is considered to be a safe and useful technique for the reconstruction of gastric conduit.

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“…Cervical anastomotic leakage was one of the most common complications after MIE with a rate of up to 35% [ 26 ]. While s ome studies had shown that the PM route was associated with a lower occurrence of anastomotic leakage compared to the ST route [ 15 – 18 ], the other revealed no difference [ 11 , 19 ]. In our study, no gastric conduit necrosis was observed.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, reconstruction through the ST route might help avoid some severe complications such as airway-gastric conduit fistula [ 10 ], hiatal and para-conduit hernia [ 11 , 12 ], and it might reduce incidences of gastroesophageal reflux [ 13 ], and pulmonary complications, particularly pneumonia compared with the PM route [ 14 ]. Meanwhile some prior studies showed a lower anastomotic leakage rate using PM route [ 15 – 18 ], the others revealed similar rates of anastomotic leakage between the two groups [ 11 , 19 ]. Two meta-analyses conducted on this issue showed no difference in postoperative outcomes for the two routes of reconstruction [ 8 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of substernal and posterior mediastinal route of reconstruction after minimally invasive esophagectomy for esophageal cancer

Dat,

Thong,

Nguyen

et al. 2024

Langenbecks Arch Surg

View full text Add to dashboard Cite

Background Substernal (ST) and posterior mediastinal (PM) routes are the two most common for reconstruction after esophagectomy with cervical anastomosis. Recent evidence showed similar outcomes between the routes; thus, the superior choice remained controversial. This study aimed to compare the short-term outcomes of the ST to the PM route for reconstruction after esophagectomy for esophageal cancer (EC). Method This retrospective cohort study included 132 patients who underwent McKeown minimally invasive esophagectomy (MIE) with gastric conduit for EC between March 2015 and December 2022. Among these, 89 and 43 patients received the ST route and PM route for reconstruction, respectively. Short-term outcomes including operative characteristics, postoperative morbidity, and mortality were evaluated. Result There was no conversion from ST to PM route. The ST group had longer operating time (375 min vs. 341 min). Oral feeding initiation, postoperative hospital stays, and overall complication rates were comparable in the two groups. The rate and severity of anastomotic leakage were similar between the groups. The ST group had a significantly lower incidence of postoperative ICU admission and pneumonia compared to the PM group (5.6% vs. 16.3% and 19.1% vs. 37.2%, respectively). Azygos vein bleeding, obstruction at feeding jejunostomy site, and conduit–trachea fistula were severe complications that only occurred in PM route. Conclusion ST route was superior to PM route in term of postoperative ICU admission and pneumonia. This route may prevent severe complications that only occur in PM route. ST route can be favorable option for reconstruction after McKeown MIE for EC.

show abstract

Laparoscopic creation of a retrosternal route for gastric conduit reconstruction

Cited by 7 publications

References 14 publications

Comparison of substernal and posterior mediastinal route of reconstruction after minimally invasive esophagectomy for esophageal cancer

Comparison of substernal and posterior mediastinal route of reconstruction after minimally invasive esophagectomy for esophageal cancer

A approach of gastric conduit via the anterior of pulmonary hilum route during minimally invasive McKeown esophagectomy

Comparison of substernal and posterior mediastinal route of reconstruction after minimally invasive esophagectomy for esophageal cancer

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