title: Appropriate routes of reconstruction following transthoracic esophagectomy.
abstract: OBJECTIVE
  The effectiveness of reconstructive methods after esophagectomy remains controversial.
  
  
  METHODS
  A total of 211 patients who underwent transthoracic esophagectomy and esophagogastric anastomosis using the gastric conduit were enrolled in this study. A retromediastinal approach was used in 79 patients and a retrosternal approach in 132. The surgical outcomes were compared between the two groups.
  
  
  RESULTS
  In the retrosternal group, anastomotic leakage (26.5%), stenosis of the anastomosis (13.6%), and respiratory complications (18.2%) were frequently observed. Five patients died of aspiration pneumonia probably due to stenosis of the anastomotic site in the retrosternal group. In the retromediastinal group, two patients died from bleeding of a peptic ulcer in the gastric conduit. Partial resection of the manubrium significantly reduced the incidence of leakage in the retrosternal group (4/29 vs. 31/68, p=0.0305). Retrosternal approach and stage were independent prognostic factors for overall survival whereas only stage was an independent prognostic factor for disease-specific survival.
  
  
  CONCLUSIONS
  Retrosternal reconstruction is suggested as the unwillingly adopted method of choice after palliative esophagectomy (R2) for the following radiotherapy. Partial resection of the bony structures can be used to prevent postoperative morbidity in this operative procedure. Retromediastinal reconstruction is the possible method of choice in patients receiving curative esophagectomy.
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University, Minami-ku, Yokohama, 232-0024, Japan. s0714@med.yokohama-cu.ac.jp
authors.forename: Chikara
authors.initials: C
authors.lastname: Kunisaki
authors.forename: Hirochika
authors.initials: H
authors.lastname: Makino
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Otsuka
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kojima
authors.forename: Ryo
authors.initials: R
authors.lastname: Takagawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Kosaka
authors.forename: Hidetaka A
authors.initials: HA
authors.lastname: Ono
authors.forename: Masato
authors.initials: M
authors.lastname: Nomura
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Akiyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D019651:Plastic Surgery Procedures