Original article
General thoracic
Anterior Versus Posterior Routes of Reconstruction After Esophagectomy: A Comparative Anatomic Study

https://doi.org/10.1016/j.athoracsur.2008.11.016Get rights and content

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.

Section snippets

Patients and Methods

Between December 2005 and October 2007, a total of 60 consecutive and nonselected patients who were diagnosed with thoracic squamous cell carcinoma of the esophagus and planned to receive esophagectomy were accrued into this institutional review board–approved prospective study. Written consents were obtained from all participating patients before their surgery. Pretreatment evaluation included a complete history and physical examination, chest roentgenogram, computed tomography of the chest

Results

The median age of all patients was 59.9 years (range, 43 to 79 years). Fifty patients were Chinese men and 10 were women.

All patients were diagnosed with esophageal squamous cell carcinoma in the thoracic esophagus. The number of lesions located in the upper, mid, and lower thoracic esophagus were 15, 33, and 12, respectively. All patients received esophagectomy as well as reconstruction using the gastric conduit through AR as planned.

The mean distances of AR and PR were 32.7 ± 2.7 cm and 35.5

Comment

Esophagectomy followed by reconstruction of the alimentary tract is the mainstay treatment for early stage resectable esophageal cancers. Alimentary tract reconstruction is commonly achieved using a gastric conduit, and can be positioned either through AR or PR [2]. Although various reasons have been cited for selection of the routes, it seems that the choices are influenced more by the preferences and experience of surgeons than by best evidence, as the data available are scarce and

References (12)

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