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. 2021 Sep 6;6(1):46-53.
doi: 10.1002/ags3.12501. eCollection 2022 Jan.

Impact of Reconstruction Route on Postoperative Morbidity After Esophagectomy: Analysis of Esophagectomies in the Japanese National Clinical Database

Hirotoshi Kikuchi  1 , Hideki Endo  2 , Hiroyuki Yamamoto  2 , Soji Ozawa  3 , Hiroaki Miyata  2 , Yoshihiro Kakeji  4   5 , Hisahiro Matsubara  6   7 , Yuichiro Doki  7   8 , Yuko Kitagawa  9   10 , Hiroya Takeuchi  1
Affiliations

Impact of Reconstruction Route on Postoperative Morbidity After Esophagectomy: Analysis of Esophagectomies in the Japanese National Clinical Database

Hirotoshi Kikuchi et al. Ann Gastroenterol Surg. .

Abstract

Background: Esophagectomy followed by gastric conduit reconstruction is a standard surgical procedure for esophageal cancer. However, there is no evidence of the superiority or inferiority of the posterior mediastinal (PM) versus the retrosternal (RS) reconstruction route with regard to short-term outcomes after esophagectomy. We aimed to elucidate whether the reconstruction route can affect the short-term outcomes after esophagectomy followed by gastric conduit reconstruction.

Methods: We reviewed the clinical data of patients who underwent esophagectomy between 2016 and 2018 from the Japanese National Clinical Database. This study included 9786 patients who underwent gastric conduit reconstruction through the PM or RS route with cervical anastomosis.

Results: Of the 9786 patients analyzed, 3478 and 6308 underwent gastric conduit reconstruction thorough the PM and RS routes, respectively. The incidence of anastomotic leak and surgical site infection (SSI) was significantly lower in the PM group than in the RS group (11.7% vs 13.8%, P = .005 and 8.4% vs 14.9%, P < .001, respectively), while the incidence of pneumonia was higher in the PM group (13.7% vs 12.2%, P = .040). Generalized estimating equation logistic regression analysis revealed a higher risk of anastomotic leak and SSI (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.15-1.51; P < .001 and OR, 2.06; 95% CI, 1.78-2.38; P < .001, respectively) and a lower risk of pneumonia (OR, 0.86; 95% CI, 0.75-0.98; P = .028) in the RS group than in the PM group.

Conclusion: The findings of this study will help surgeons to design the reconstruction route following esophagectomy.

Keywords: anastomotic leak; national clinical database; pneumonia; posterior mediastinal route; retrosternal route; surgical site infection.

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Conflict of interest statement

Conflict of interest: Hideki Endo, Hiroyuki Yamamoto, and Hiroaki Miyata are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo. The other authors have no conflicts of interest. Ethical approval: The protocol for this research project was approved by the Ethics Committee of Hamamatsu University School of Medicine (Approval number: 19‐102), and it conforms to the provisions of the Declaration of Helsinki. The opt‐out method to obtain patient consent was utilized at each institution.

Figures

FIGURE 1
FIGURE 1
Selection process for the study population
FIGURE 2
FIGURE 2
Risk comparison of postoperative morbidities between the posterior mediastinal (PM) and retrosternal (RS) groups. Circles represent the estimate of odds ratio and bars represent their 95% confidence interval (CI)
See this image and copyright information in PMC

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