Impact on outcome of the route of conduit transposition after transhiatal oesophagectomy: A randomized controlled trial

Impact of the Route of Reconstruction on Post‐operative Morbidity and Malnutrition after Esophagectomy: A Multicenter Cohort Study

“…The present study showed that pre‐operative body weight and the reconstruction route, but not neoadjuvant therapy or female sex, were independently associated with 1‐year malnutrition after surgery. Previous prospective randomized studies showed no difference in post‐operative body weight loss between the reconstruction routes [11, 13, 15]. One previous study reported that the retention of a liquid or solid was significantly higher in the retrosternal placed tube, compared with posterior mediastinal placement [11].…”

“…Although both routes are widely used, it is difficult to conduct a large‐scale randomized controlled trial because the surgeon often prefers one standard approach. To date, there is no consensus on the optimal route of reconstruction after esophagectomy with cervical esophagogastric anastomosis [11–16]. In the present study, we assessed the impact of the method of conduit reconstruction on perioperative morbidity, mortality, long‐term nutritional status, and survival at 1 year after esophagectomy for ESCC in a large cohort of consecutive patients from three high volume centers.…”

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

“…Pulmonary complications are the most frequent nonsurgical complications (approximately 15%), 21,38 and we previously reported that pulmonary complications have a significant negative effect on overall survival after esophagectomy. [39][40][41] Our meta-analysis evaluated the impact of reconstruction routes on pulmonary complications in five RCTs comprising 125 posterior mediastinal and 129 retrosternal cases, 19,[22][23][24][25][26] nine case-control trials including 692 posterior mediastinal and 768 retrosternal case, 19,20,28,30,[33][34][35][36][37] and NCD analysis involving 3478 posterior mediastinal and 6308 retrosternal cases (Figure 2B). Our meta-analysis revealed no significant difference in pulmonary complications between the posterior mediastinal and retrosternal groups (OR = 0.80, 95% CI: 0.58-1.11, p = 0.19).…”

“…NCD revealed a decreasing trend in mortality rate for esophagectomy from 3.2% in 2011 to 1.5% in 2020, which is similar to the mortality rate for total gastrectomy. 10 Our meta-analysis evaluated the effect of reconstruction routes on mortality in five RCTs including 125 posterior mediastinal and 129 retrosternal cases, 19,[22][23][24][25][26] five case-control trials comprising 464 posterior mediastinal and 424 retrosternal cases, 18,19,30,33,35,36 and NCD analysis involving 3478 posterior mediastinal and 6308 retrosternal cases 7 (Figure 2C). Similar to NCD analysis, our meta-analysis revealed no significant difference in mortality between the posterior mediastinal and retrosternal groups (OR = 0.79, 95% CI: 0.56-1.12, p = 0.19).…”

“…Our meta‐analysis evaluated the impact of reconstruction routes on anastomotic leakage in six RCTs including 192 posterior mediastinal and 169 retrosternal cases, 19 , 22 , 23 , 24 , 25 , 26 , 27 12 case–control trials comprising 979 posterior mediastinal and 1226 retrosternal cases, 18 , 19 , 20 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 and NCD analysis including 3478 posterior mediastinal and 6308 retrosternal cases 7 (Figure 2A ). Our meta‐analysis showed that the posterior mediastinal route was significantly associated with a lower anastomotic leakage rate than the retrosternal route (OR = 0.78, 95% CI: 0.70–0.87, p < 0.0001).…”