Anterior versus posterior routes of reconstruction after esophagectomy: a comparative anatomic study.
BACKGROUND
A gastric conduit is commonly used to reconstruct the alimentary tract after esophagectomy for esophageal cancer. The choice of anterior versus posterior route for reconstruction is debatable, and longer distance of the reconstructed routes may be associated with higher tension exerted on the transposed stomach. The aim of this study is to evaluate the length of both the anterior and posterior routes in a group of patients measured intraoperatively during esophagectomy for esophageal cancer.


METHODS
Sixty consecutive and nonselected patients with thoracic esophageal cancer were accrued in this prospective study. Measurements of the anterior (retrosternal) and posterior routes were performed after esophagectomy but before reconstruction with gastric conduit, from the cricoid cartilage to the pyloric ring.


RESULTS
The lengths of the anterior and posterior routes were 32.68 +/- 2.67 cm and 35.48 +/- 2.93 cm, respectively (p < 0.001). The anterior route is significantly shorter than the posterior route.


CONCLUSIONS
The anterior (retrosternal) route is the shorter passage for the reconstruction of the alimentary tract using the stomach after esophagectomy.
Chen
Haiquan
H
Department of Cardiothoracic Surgery, The Cancer Hospital of Fudan University, Shanghai, China. hqchen1@yahoo.com
Lu
Jiade J
JJ
Zhou
Jianhua
J
Zhou
Xian
X
Luo
Xiaoyang
X
Liu
Quan
Q
Tam
John
J
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D004947:Esophagus / Q000033:anatomy & histology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology; D011336:Probability; D011446:Prospective Studies; D011708:Pylorus / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment; D015996:Survival Rate; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome