Impact of Reconstruction Route on Postoperative Morbidity After Esophagectomy: Analysis of Esophagectomies in the Japanese National Clinical Database

Abstract

Background: Esophagectomy followed by gastric conduit reconstruction is a standard surgical procedure for esophageal cancer. However, there is no evidence of the superiority or inferiority of the posterior mediastinal (PM) versus the retrosternal (RS) reconstruction route with regard to short-term outcomes after esophagectomy.We aimed to elucidate whether the reconstruction route can affect the short-term outcomes after esophagectomy followed by gastric conduit reconstruction. Methods:We reviewed the clinical data of patients who underwent esophagectomy between 2016 and 2018 from the Japanese National Clinical Database. This study included 9786 patients who underwent gastric conduit reconstruction through the PM or RS route with cervical anastomosis. Results:Of the 9786 patients analyzed, 3478 and 6308 underwent gastric conduit reconstruction thorough the PM and RS routes, respectively. The incidence of anastomotic leak and surgical site infection (SSI) was significantly lower in the PM group than in the RS group (11.7% vs 13.8%, P = .005 and 8.4% vs 14.9%, P < .001, respectively), while the incidence of pneumonia was higher in the PM group (13.7% vs 12.2%, P = .040). Generalized estimating equation logistic regression analysis revealed a higher risk of anastomotic leak and SSI (odds ratio [OR], 1.

Annual report on National Clinical Database 2020 for gastroenterological surgery in Japan

“…With respect to the other issues of postoperative mortality and morbidity rates in the NCD, the impact of reconstruction route on postoperative morbidity after esophagectomy was reported 41 . The Glasgow prognostic score was shown to be strongly correlated with postoperative outcomes 42 .…”

Nationwide Validation Study of the Prognostic Significance of Stratification Using Pathological Stage and Response to Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma

“…Transthoracic esophagectomy with right thoracotomy and gastric tube reconstruction through the posterior mediastinal or retrosternal route was performed as the standard curative surgical procedure in Japan 12 . The extent of LN dissection was based on the 2017 JES esophageal cancer practice guidelines 13,14 .…”

“…Transthoracic esophagectomy with right thoracotomy and gastric tube reconstruction through the posterior mediastinal or retrosternal route was performed as the standard curative surgical procedure in Japan. 12 The extent of LN dissection was based on the 2017 JES esophageal cancer practice guidelines. 13,14 Mediastinal LNs with bilateral recurrent nerves and abdominal LNs, such as the paracardial LNs and LNs along the lesser curvature and the left gastric artery, were routinely dissected.…”

Man with shortness of breath after meal

“…Reconstructed gastric conduit in posterior mediastinum is common after esophagectomy. 1 Despite its relative safety, 2 tracheal compression can occur because of the trachea's proximity. Gastric conduit dilation is reportedly caused by recurrent cancer, gastric conduit hernia, and paraconduit hernia.…”

“…Reconstructed gastric conduit in posterior mediastinum is common after esophagectomy 1 . Despite its relative safety, 2 tracheal compression can occur because of the trachea's proximity.…”