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. 2017 Dec;9(12):5040-5045.
doi: 10.21037/jtd.2017.11.51.

Substernal reconstruction following esophagectomy: operation of last resort?

Jacob R Moremen  1 , DuyKhanh P Ceppa  2 , Karen M Rieger  2 , Thomas J Birdas  2
Affiliations

Substernal reconstruction following esophagectomy: operation of last resort?

Jacob R Moremen et al. J Thorac Dis. 2017 Dec.

Abstract

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.

Keywords: Esophagectomy; outcomes; reconstruction; substernal.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

References

    1. Moremen JR, Skopelja EN, Ceppa DP. The role of induction therapy. J Thorac Dis 2014;6 Suppl 3:S309-13. - PMC - PubMed
    1. Zheng YZ, Dai SQ, Li W, et al. Comparison between different reconstruction routes in esophageal squamous cell carcinoma. World J Gastroenterol 2012;18:5616-21. 10.3748/wjg.v18.i39.5616 - DOI - PMC - PubMed
    1. Zaninotto G, Low DE. Complications after esophagectomy: it is time to speak the same language. Dis Esophagus 2016;29:580-2. 10.1111/dote.12375 - DOI - PubMed
    1. Coral RP, Constant-Neto M, Silva IS, et al. Comparative anatomical study of the anterior and posterior mediastinum as access routes after esophagectomy. Dis Esophagus 2003;16:236-8. 10.1046/j.1442-2050.2003.00335.x - DOI - PubMed
    1. Anegg U, Lindenmann J, Maier A, et al. Influence of route of gastric transposition on oxygen supply at cervical oesophagogastric anastomoses. Br J Surg 2008;95:344-9. 10.1002/bjs.5997 - DOI - PubMed