Abstract
Background
The gastric tube reconstruction route after esophagectomy is generally adopted posterior mediastinal or retrosternal route. Currently it is selected for each hospital or case. Preoperative and postoperative nutritional assessment, surgical complications and rate of survival are retrospectively compared between Posterior mediastinal routec(Group P) and Retrosternal route (Group R).
Methods
From January 2006 to December 2015, 198 patients with gastric tube reconstruction after esophagectomy (112 patients in Group P and 86 patients in Group R) were included. Propensity score was calculated and adjusted by multiple logistic regression analysis because bias of background factors occurs. 1) Surgical complications and survival rate, 2) CONUT score as a nutritional evaluation index before, 6 months and 12 months after surgery, 3) Endoscopic findings at 12 months after surgery were examined.
Results
In Group R, there were more advanced cases with thoracotomy than Group P. As a result of matching these factors as covariates using Propensity score, 27 groups were extracted in each group. 1) Surgical complications and survival rate: There was no difference in the incidence of complications such as arrhythmia, suture failure, pulmonary complications between the two groups. There was no difference between PFS and OS in the two groups. 2) Nutritional Evaluation Indicator: The patients who recognized malnutrition (CONUT score 3 or more) before surgery (group P 9.3% vs. group R 7.4%, P = 0.715), 6 months after surgery (18.0% vs 15.4%, P = 1.000), 12 months after surgery (8.6% vs 22.9%, P = 0.049), group P had good nutritional status for 12 months postoperatively. 3) Endoscopic findings: Anastomotic stenosis (group P 22.5% vs. group R 10.2%, P = 0.052) tended to be few in group R. The occurrence of reflux esophagitis and food residue stagnation was not different between both groups.
Conclusion
Although short-term benefits such as ease of response to postoperative recurrence and postoperative complications are considered to be in retrosternal reconstruction, as the results of esophageal cancer treatment outcome improve, longer term of nutrition etc is taken from the viewpoint. The posterior mediastinal route is the first choice in our department.
Disclosure
All authors have declared no conflicts of interest.
A CASE OF RECONSTRUCTED GASTRIC TUBE ULCER THROUGH POSTERIOR MEDIASTINAL ROUTE AFTER ESOPHAGECTOMY WITH CARDIAC TAMPONADE
