Randomized comparison of prevertebral and retrosternal gastric tube reconstruction after resection of oesophageal carcinoma

Lanschot, J. Jan B. van; Blankenstein, M. van; Oei, H. Y.; Tilanus, Hugo W.

doi:10.1046/j.1365-2168.1999.00981.x

Cited by 92 publications

(75 citation statements)

References 18 publications

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“…In one randomized study, postoperative recovery, anastomotic leakage and benign stricture formation were not significantly different between the two routes of reconstruction. Functional results, as measured by scintigraphic gastric emptying, quantitative and qualitative oral food intake, and changes in body weight were also similar [5]. In contrast, two studies demonstrated a higher cardiopulmonary complication rate.…”

Section: Discussionmentioning

confidence: 99%

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Influence of the Route of Reconstruction on Morbidity, Mortality and Local Recurrence after Esophagectomy for Cancer

2003

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Background: A choice of retrosternal or orthotopic route for reconstruction exists after three-phase esophagectomy with cervical anastomosis. Whether the route of reconstruction affects postoperative morbidity, mortality and recurrence patterns remains controversial. Study Design: Patients with cancer of the thoracic esophagus who underwent three-phase esophagectomy between 1990 and 1999 were studied. Postoperative outcome, recurrence patterns and survival were analyzed from a prospectively collected database. Results: Seventy-five patients underwent three-phase esophagectomy. There were 46 patients in the retrosternal group and 29 in the orthotopic group. The mean age of the retrosternal group was younger than the orthotopic group, 60 and 66 years, respectively (p = 0.004). The retrosternal group also had more advanced disease; 24% of patients had curative resection compared with 59% in the orthotopic group (p = 0.003). There was no significant difference in postoperative complications except that the retrosternal group had more blood loss, median 800 ml compared with 700 ml (p = 0.04). Hospital mortality was 13% in the retrosternal group and 3.4% in the orthotopic group (p = 0.24). Multivariate analysis showed that age (odds ratio 1.16, p = 0.035) and pulmonary risk (odds ratio 10, p = 0.01) were predictive of hospital mortality, but not the route of reconstruction. No patient in the retrosternal group developed recurrence in the gastric conduit compared to 4 of 28 patients (14%) in the orthotopic group (p = 0.03). Two of these patients were symptomatic with bleeding from the intragastric recurrence. Survival was worse in the retrosternal group, 5-year survival was 29.8 vs. 8.2% (p < 0.01), reflecting the more advanced disease and higher prevalence of palliative resections. Conclusions: Cardiopulmonary complications and hospital mortality were not significantly different in the two groups. Recurrent tumor infiltration of the gastric conduit occurred in 14% of patients when the orthotopic route was used.

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Section: Discussionmentioning

confidence: 99%

“…After subtotal resection with anastomosis in the neck, there is a choice of placing the conduit in the orthotopic, retrosternal, or subcutaneous route [2, 3, 4, 5, 6]. The subcutaneous route is rarely used because it is cosmetically unsightly.…”

Section: Introductionmentioning

confidence: 99%

Influence of the Route of Reconstruction on Morbidity, Mortality and Local Recurrence after Esophagectomy for Cancer

2003

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“…The neoesophagus is routinely positioned in the esophageal bed, i.e., in the posterior mediastinum. When the surgical resection is macroscopically irradical, and thus symptomatic locoregional tumor recurrence can be expected shortly after the operation, the retrosternal or subcutaneous route is chosen [1]. Occasionally the stomach is not available for esophageal substitution, e.g., in patients with previous gastric resection, or in those with an esophageal tumor which infiltrates the stomach well beyond the cardia precluding a tumor-free distal resection margin and thus necessitating a total gastrectomy (in addition to resection of the esophagus).…”

Section: Introductionmentioning

confidence: 99%

Quality of life after colon interposition by necessity for esophageal cancer replacement

Cense

Visser

Sandick

et al. 2004

Journal of Surgical Oncology

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“…Some reports have shown no difference between the SR and PM techniques in the perioperative complications and functional outcomes (13)(14)(15). Zheng et al found a significant association (P=0.018) between anastomotic stricture and use of SR (2).…”

Section: Discussionmentioning

confidence: 99%

Substernal reconstruction following esophagectomy: operation of last resort?

Moremen¹,

Ceppa²,

Rieger³

et al. 2017

J. Thorac. Dis.

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Background:The posterior mediastinum is the preferred location for reconstruction following esophagectomy. Occasionally alternative routes are required. We examined patient outcomes of esophageal reconstruction in order to determine whether substernal reconstruction (SR) is an equivalent alternative to orthotopic placement. Methods: Following IRB approval, we performed a retrospective review of all patients who underwent an esophagectomy from 1988-2014. Only patients reconstructed with a gastric conduit and cervical anastomosis by either substernal or posterior mediastinal (PM) routes were included in the study. Endpoints assessed included anastomotic leak rate, post-operative complications, reoperation, hospital length of stay, and 30-and 90-day mortality. Results: Thirty-three patients underwent SR and 182 had a PM gastric conduit with cervical anastomosis.The SR pathology was predominantly benign while PM was mostly malignant. Sixteen SR patients had a delayed reconstruction after prior diversion. Mean hospital LOS was longer in the SR group (P<0.001).There was no significant difference in 30-and 90-day mortality. PM patients had significantly fewer respiratory complications (P<0.04), reoperations (P<0.04), and transfusions (P<0.0001) and a trend towards fewer anastomotic leaks (17.1% vs. 30.3%; P<0.09). Conclusions: This single institution experience demonstrated no significant difference in mortality between substernal and PM reconstruction following esophagectomy. However, SR was associated with significantly increased LOS and morbidity, including a trend toward increased anastomotic leaks. SR reconstruction should probably be considered an option of last resort.

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Randomized comparison of prevertebral and retrosternal gastric tube reconstruction after resection of oesophageal carcinoma

Cited by 92 publications

References 18 publications

Influence of the Route of Reconstruction on Morbidity, Mortality and Local Recurrence after Esophagectomy for Cancer

Influence of the Route of Reconstruction on Morbidity, Mortality and Local Recurrence after Esophagectomy for Cancer

Quality of life after colon interposition by necessity for esophageal cancer replacement

Substernal reconstruction following esophagectomy: operation of last resort?

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