title: Intrathoracic versus cervical anastomosis after resection of esophageal cancer: a matched pair analysis of 72 patients in a single center study.
abstract: BACKGROUND
  The aim of this study was to analyze the early postoperative outcome of esophageal cancer treated by subtotal esophageal resection, gastric interposition and either intrathoracic or cervical anastomosis in a single center study.
  
  
  METHODS
  72 patients who received either a cervical or intrathoracic anastomosis after esophageal resection for esophageal cancer were matched by age and tumor stage. Collected data from these patients were analyzed retrospectively regarding morbidity and mortality rates.
  
  
  RESULTS
  Anastomotic leakage rate was significantly lower in the intrathoracic anastomosis group than in the cervical anastomosis group (4 of 36 patients (11%) vs. 11 of 36 patients (31%); p = 0.040). The hospital stay was significantly shorter in the intrathoracic anastomosis group compared to the cervical anastomosis group (14 (range 10-110) vs. 26 days (range 12 - 105); p = 0.012). Wound infection and temporary paresis of the recurrent laryngeal nerve occurred significantly more often in the cervical anastomosis group compared to the intrathoracic anastomosis group (28% vs. 0%; p = 0.002 and 11% vs. 0%; p = 0.046). The overall In-hospital mortality rate was 6% (4 of 72 patients) without any differences between the study groups.
  
  
  CONCLUSIONS
  The present data support the assumption that the transthoracic approach with an intrathoracic anastomosis compared to a cervical esophagogastrostomy is the safer and more beneficial procedure in patients with carcinoma of the lower and middle third of the esophagus due to a significant reduction of anastomotic leakage, wound infection, paresis of the recurrent laryngeal nerve and shorter hospital stay.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Aachen, Germany. cklink@ukaachen.de
authors.forename: Christian D
authors.initials: CD
authors.lastname: Klink
authors.forename: Marcel
authors.initials: M
authors.lastname: Binnebösel
authors.forename: Jens
authors.initials: J
authors.lastname: Otto
authors.forename: Gabriele
authors.initials: G
authors.lastname: Boehm
authors.forename: Klaus T
authors.initials: KT
authors.lastname: von Trotha
authors.forename: Ralf-Dieter
authors.initials: RD
authors.lastname: Hilgers
authors.forename: Joachim
authors.initials: J
authors.lastname: Conze
authors.forename: Ulf P
authors.initials: UP
authors.lastname: Neumann
authors.forename: Marc
authors.initials: M
authors.lastname: Jansen
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate