title: Comparison between different reconstruction routes in esophageal squamous cell carcinoma.
abstract: OBJECTIVE
  To compare postoperative complications and prognosis of esophageal squamous cell carcinoma patients treated with different routes of reconstruction.
  
  
  METHODS
  After obtaining approval from the Medical Ethics Committee of the Sun Yat-Sen University Cancer Center, we retrospectively reviewed data from 306 consecutive patients with histologically diagnosed esophageal squamous cell carcinoma who were treated between 2001 and 2011. All patients underwent radical McKeown-type esophagectomy with at least two-field lymphadenectomy. Regular follow-up was performed in our outpatient department. Postoperative complications and long-term survival were analyzed by treatment modality, baseline patient characteristics, and operative procedure. Data from patients treated via the retrosternal and posterior mediastinal routes were compared.
  
  
  RESULTS
  The posterior mediastinal and retrosternal reconstruction routes were employed in 120 and 186 patients, respectively. Pulmonary complications were the most common complications experienced during the postoperative period (46.1% of all patients; 141/306). Compared to the retrosternal route, the posterior mediastinal reconstruction route was associated with a lower incidence of anastomotic stricture (15.8% vs 27.4%, P = 0.018) and less surgical bleeding (242.8 ± 114.2 mL vs 308.2 ± 168.4 mL, P < 0.001). The median survival time was 26.8 mo (range: 1.6-116.1 mo). Upon uni/multivariate analysis, a lower preoperative albumin level (P = 0.009) and a more advanced pathological stage (pT; P = 0.006; pN; P < 0.001) were identified as independent factors predicting poor prognosis. The reconstruction route did not influence prognosis (P = 0.477).
  
  
  CONCLUSIONS
  The posterior mediastinal route of reconstruction reduces incidence of postoperative complications but does not affect survival. This route is recommended for resectable esophageal squamous cell carcinoma.
authors.affiliation: Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, No.651, Dongfeng Road East, Guangzhou, GuangdongProvince, China. zhengyzh@sysucc.org.cn
authors.forename: Yu-Zhen
authors.initials: YZ
authors.lastname: Zheng
authors.forename: Shu-Qin
authors.initials: SQ
authors.lastname: Dai
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Xun
authors.initials: X
authors.lastname: Cao
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Fu
authors.forename: Peng
authors.initials: P
authors.lastname: Lin
authors.forename: Lan-Jun
authors.initials: LJ
authors.lastname: Zhang
authors.forename: Bin
authors.initials: B
authors.lastname: Lu
authors.forename: Jun-Ye
authors.initials: JY
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D002681:China / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D004944:Esophagoplasty / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies
keywords: Comparison; Esophageal carcinoma; Posterior mediastinal; Retrosternal; Route of reconstruction