title: Impact of the route of reconstruction on post-operative morbidity and malnutrition after esophagectomy: a multicenter cohort study.
abstract: BACKGROUND
  Reconstruction after esophagectomy is mainly performed through the retrosternum (RS) or posterior mediastinum (PM). However, the best approach is not clear. This study aimed to assess the impact of the route of gastric conduit reconstruction, after esophagectomy for esophageal squamous cell carcinoma (ESCC), on post-operative outcomes.
  
  
  METHODS
  We analyzed 298 patients who underwent radical esophagectomy for ESCC at three high volume centers between 2008 and 2009. Among them, the RS was selected in 166 patients and PM in 118; while, the antethoracic route was used in 14 patients. Post-operative morbidity, mortality, and long-term outcome were compared.
  
  
  RESULTS
  There were no differences between patients of the two routes with respect to operative blood loss (RS: 753 ± 519, PM: 748 ± 414 g) and post-operative complications, including pulmonary problems (RS: 15 %, PM: 10.2 %) and anastomotic leakage (RS: 9.0 %, PM: 5.1 %); although, the operating time (RS: 566 ± 97, PM: 472 ± 79 min; p < 0.0001) was shorter in the PM group than the RS group. The percentage weight loss after surgery was significantly less in the PM group than the RS group at 1 year (8.6 vs. 11.1 %; p = 0.025); although, the percentage at discharge was not different between the groups (PM: 4.9 %, RS: 6.3 %; p = 0.072). Multivariate analysis identified pre-operative body weight and the reconstruction route as significant and independent factors associated with 1-year weight loss.
  
  
  CONCLUSIONS
  The results indicate gastric tube reconstruction through the posterior mediastinal route after esophagectomy may relieve post-operative 1-year malnutrition without increasing post-operative complications.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0879, Japan, myamasaki@gesurg.med.osaka-u.ac.jp.
authors.forename: Makoto
authors.initials: M
authors.lastname: Yamasaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyata
authors.forename: Takushi
authors.initials: T
authors.lastname: Yasuda
authors.forename: Osamu
authors.initials: O
authors.lastname: Shiraishi
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takahashi
authors.forename: Masaaki
authors.initials: M
authors.lastname: Motoori
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yano
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Shiozaki
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology; D016063:Blood Loss, Surgical; D001835:Body Weight; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D004944:Esophagoplasty / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000209:etiology; D008482:Mediastinum / Q000601:surgery; D008875:Middle Aged; D009752:Nutritional Status; D061646:Operative Time; D013249:Sternum / Q000601:surgery; D015996:Survival Rate; D014826:Vocal Cord Paralysis / Q000209:etiology; D015431:Weight Loss