A comparative study of the lengths of different reconstruction routes used after thoracic esophagectomy

Yasuda, Takushi; Shiraishi, Osamu; Katô, Hiroaki; Hirabayashi, Yoko; Momose, Kazunari; Yasuda, Atsushi; Shinkai, Masayuki; Kimura, Yutaka; Imano, Motohiro

doi:10.1007/s10388-020-00805-x

Cited by 6 publications

(25 citation statements)

References 15 publications

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“…12 A reasonable strategy to prevent anastomotic leakage is to pull up the reconstructed organs through the shortest route because the blood flow worsens when approaching the tip of the reconstructed organ. 6 To date, several studies have compared the lengths of the three reconstruction routes (Table 1). 6,[13][14][15][16][17][18] The subcutaneous route is longer than the posterior mediastinal and retrosternal routes.…”

Section: Comparison Of the Leng Th S Of The P Os Teri Or Med Ia S Tin...mentioning

confidence: 99%

What is the best reconstruction procedure after esophagectomy? A meta‐analysis comparing posterior mediastinal and retrosternal approaches

Booka

Takeuchi

Morita

et al. 2023

Annals of Gastroent Surgery

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Thoracic esophagectomy is a particularly invasive and complicated surgical procedure, with a reconstruction of the gastrointestinal tract, such as the stomach, jejunum, or colon. The posterior mediastinal, retrosternal, and subcutaneous routes are the three possible esophageal reconstruction routes. Each route has advantages and disadvantages, and the optimal reconstruction route after esophagectomy remains controversial. Additionally, the best anastomotic techniques after esophagectomy in terms of location (Ivor Lewis or McKeown) and suturing (manual or mechanical) are debatable. Our meta‐analysis investigating postoperative complications after esophagectomy between the posterior mediastinal and retrosternal routes revealed that the posterior mediastinal route was associated with a significantly lower anastomotic leakage rate than the retrosternal route (odds ratio = 0.78, 95% confidence interval: 0.70–0.87, p < 0.0001). Conversely, pulmonary complications (odds ratio = 0.80, 95% confidence interval: 0.58–1.11, p = 0.19) and mortality between the posterior mediastinal and retrosternal routes (odds ratio = 0.79, 95% confidence interval: 0.56–1.12, p = 0.19) were not significantly different. However, the incidence of pneumonia may be lower when using the retrosternal route rather than the posterior mediastinal route for performing minimally invasive esophagectomy. The McKeown procedure is oncologically necessary for tumors located above the carina to dissect upper mediastinal and cervical lymph nodes; however, the Ivor Lewis procedure offers perioperative and oncological safety for tumors located under the carina. An individualized treatment strategy for selecting the optimal reconstruction procedure can be proposed in future studies based on oncological and patient risk factors considering mid‐ to long‐term quality of life.

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Section: Comparison Of the Leng Th S Of The P Os Teri Or Med Ia S Tin...mentioning

confidence: 99%

What is the best reconstruction procedure after esophagectomy? A meta‐analysis comparing posterior mediastinal and retrosternal approaches

Booka

Takeuchi

Morita

et al. 2023

Annals of Gastroent Surgery

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“…Presently, the methods of esophageal reconstruction using various colon segments, such as ileum-transverse colon segment, ascending colon-transverse colon segment, and transverse colon-descending colon segment, have been reported ( 1 , 10 ). Many operative methods of colon interposition proposed previously are based on the transplantation of the transverse colon, a part of the descending colon along the peristaltic direction with blood supply from the left colonic artery as the main stem of the left colonic artery has a constant origin, and the marginal blood vessels are complete ( 11 ). This report describes the interposition method without the complete detachment of the transplanted colon ( Figure 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…Compared to the stomach and jejunum, the colon has stable and uniform contraction, suitable for food delivery ( 8 ). As a graft, the colon could provide sufficient length ( 11 ). Therefore, using the colon as a graft instead of the esophagus leads to better food satisfaction and quality of life than other organs ( 9 , 13 ).…”

Section: Discussionmentioning

confidence: 99%

Distal-continual colon interposition for esophageal reconstruction after esophagectomy: Two case reports

Guo

Zhao

et al. 2023

Front. Surg.

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BackgroundColon interposition is a complex and time-consuming procedure requiring at least three or four digestive anastomoses. However, the long-term functional outcomes are promising, with an acceptable operative risk.Case presentationHerein, two cases of esophageal carcinoma that received esophagus reconstruction using the distal continual colon interposition technique have been described. The transverse colon was lifted to the thoracic cavity for the end-to-side anastomosis with the esophagus, and a closure device was used to close the colon instead of severing and isolating the distal end. The duration of the operation was 140 and 150 min, respectively. The blood supply of the colon was maintained during the intervention. The tension-free anastomosis was performed without severe complications, and oral food intake was resumed on postoperative day 6. Neither anastomotic stenosis, antiacid or heartburn, dysphagia, or emptying obstacles nor complaints of diarrhea, bloating, or malodor were reported during the follow-up period.ConclusionsThe modified distal-continual colon interposition technique may have the advantages of a short operation time and potential prevention of serious complications caused by the torsion of mesocolon vessels.

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“…In our study, the origin of the GDA was measured, as the point fixed in the retroperitoneum was easily identified on CT images and did not shift during surgery. Some previous studies have reported that the PM route is the shortest [16][17][18], whereas others have reported that the RS route is the shortest [19][20][21]. Given these contrasting results, there remains a lack of consensus on the shortest route.…”

Section: Plos Onementioning

confidence: 95%

“…The reconstruction route and organs are selected after considering the safety issues and postoperative quality of life, and the preferred surgical procedure depends on the individual institute or surgeon. Although several studies have explored the shortest reconstruction route after subtotal esophagectomy, there remains a lack of consensus on the optimal route for the reconstruction [16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

An individual’s physique is associated with the length of the reconstruction route via the retrosternal approach

et al. 2023

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We hypothesized that an individual’s physique is related to reconstruction length, as organs reconstructed via the retrosternal route are curved toward the ventral side. This study aimed to determine factors contributing to the reconstruction length of the retrosternal route. Fifty patients underwent subtotal esophagectomy with esophagogastric reconstruction via the posterior mediastinal route between 2010 and 2014; the esophagus–stomach and posterior mediastinal route lengths were measured to evaluate whether they could be approximated. Forty patients underwent reconstruction via the retrosternal route between 2015 and 2020; the esophagus–stomach and retrosternal route lengths were compared, and contributing factors were analyzed. Each length was measured perioperatively using three-dimensional enhanced computed tomography images. The associated factors obtained included age, sex, height, body weight, body mass index, thickness and height of the thorax, depth of the thoracic inlet space, thoracic curve, left hepatic lobe volume, and the thickness and height of the liver. The length of the esophagus–stomach could approximate that of the posterior mediastinal route [posterior mediastinal-esophagus–stomach; 0.04 (-0.5–0.6) cm, p = 0.77]. Using three-dimensional enhanced computed tomography images, the lengths of the esophagus–stomach and retrosternal routes were comparable, despite variability [retrosternal-esophagus–stomach; 0.72 (-0.1–1.8) cm, p = 0.095]. Analyzing factors associated with the length revealed a positive correlation of body weight, body mass index, and thickness of the thorax with the difference. A higher body mass index (OR = 1.7, 95% CI 1.1–2.8, p = 0.007) was associated with a longer retrosternal route in the multivariate analysis. An individual’s physique is associated with the reconstruction length; particularly, the length of the retrosternal route was longer in patients with a high body mass index.

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A comparative study of the lengths of different reconstruction routes used after thoracic esophagectomy

Cited by 6 publications

References 15 publications

What is the best reconstruction procedure after esophagectomy? A meta‐analysis comparing posterior mediastinal and retrosternal approaches

What is the best reconstruction procedure after esophagectomy? A meta‐analysis comparing posterior mediastinal and retrosternal approaches

Distal-continual colon interposition for esophageal reconstruction after esophagectomy: Two case reports

An individual’s physique is associated with the length of the reconstruction route via the retrosternal approach

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