Effect of retrosternal <i>versus</i> posterior mediastinum approach for tubular stomach reconstruction on early surgical complications and short-term quality of life in patients with McKeown esophagectomy: A case control study _Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Xiaobin , YANG Yu , SUN Yifeng , GUO Xufeng , YE Bo , HUA Rong , MAO Teng ,  LI Zhigang

Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, P.R.China;

Corresponding author：

LI Zhigang, Email: zhigang.li@shchest.org

Keywords：

Esophageal squamous cell carcinoma; tubular stomach; quality of life

DOI：

10.7507/1007-4848.201701020

Video：

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Objective To compare short-term quality of life and postoperative complications in esophageal squamous cell carcinoma patients with different routes reconstruction after McKeown esophagectomy. Methods The clinical data of 144 patients with esophageal squamous cell carcinoma who received McKeown esophagectomy in Shanghai Chest Hospital from January 2016 to October 2016 were retrospectively reviewed. Among them 93 patients accepted retrosternal approach (a RR group, 71 males and 22 females at an average age of 63.5±7.7 years) and 51 patients accepted posterior mediastinal approach (a PR group, 39 males and 12 females at an average age of 62.3±8.0 years). Short-term surgical outcomes were compared and a Quality of Life Questionnaire of Patients Underwent Esophagectomy 1.0 was performed at postoperative 1^st and 3^rd month. Results There was no difference in two groups in sex, age, Body Mass Index (BMI), and location and clinical stage of tumors (P>0.05). The neoadjuvant therapy was more performed in the RR group (16.1%vs. 5.9%, P=0.075). There were more robot-assisted esophagecctomy operations performed in the PR group (52.9% vs. 45.2%, P=0.020). No significant difference was noted in operation duration, intraoperative blood loss or length of ICU stay between the RR and PR groups (251.3±59.1 min vs. 253.1±27.7 min, P=0.862; 223.7±75.1 ml vs. 240.0±75.1 ml, P=0.276; 3.7±6.6 d vs. 2.3±2.1 d, P=0.139). The patients in the PR group had more lymph nodes dissected and shorter hospital stay (P<0.001). Rate of R1/2 resection was higher in the RR group (12.9%vs. 5.9%, P=0.187). No surgery-related mortality was observed in both groups. The anastomotic leak and the anastomotic stricture was higher in the RR group than that in the PR group (25.8% vs. 5.9%, P=0.003). No significant difference was found between the two groups in the quality of life at postoperative 1^st and 3^rd month. However, the quality of life at postoperative 3^rd month significantly improved in both groups (P<0.001). Compared with the PR group, the dysphagia was more severe in the RR group at postoperative 1^st month (3.3±1.5 vs. 2.6±1.1, P=0.007), while the reflux symptom was lighter at postoperative 3^rd month (3.0±1.8 vs. 3.6±1.6, P=0.045). Conclusion The two different routes reconstruction after McKeown esophagectomy are both safe and feasible. The anterior mediastinal approach increases the risk of anastomotic leak, but with low incidence of reflux symptom.

Citation： ZHANG Xiaobin, YANG Yu, SUN Yifeng, GUO Xufeng, YE Bo, HUA Rong, MAO Teng, LI Zhigang. Effect of retrosternal versus posterior mediastinum approach for tubular stomach reconstruction on early surgical complications and short-term quality of life in patients with McKeown esophagectomy: A case control study . Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(2): 143-147. doi: 10.7507/1007-4848.201701020 Copy

1.	Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2): 69-90.
2.	Ye B, Zhong CX, Yang Y, et al. Lymph node dissection in esophageal carcinoma: Minimally invasive esophagectomy versus open surgery. World J Gastroenterol, 2016, 22(19): 4750-4756.
3.	Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg, 2012, 256(1): 95-103.
4.	Osugi H, Takemura M, Higashino M, et al. A comparison of video-assisted thoracoscopic oesophagectomy and radical lymph node dissection for squamous cell cancer of the oesophagus with open operation. Br J Surg, 2003, 90(1): 108-113.
5.	冯明祥, 王群, 蒋伟, 等. 食管癌切除管状胃不同上提路径的比较. 中华胃肠外科杂志, 2010, 13(1): 33-35.
6.	Anegg U, Lindenmann J, Maier A, et al. Influence of route of gastric transposition on oxygen supply at cervical oesophagogastric anastomoses. Br J Surg, 2008, 95(3): 344-349.
7.	Zheng YZ, Dai SQ, Li W, et al. Comparison between different reconstruction routes in esophageal squamous cell carcinoma. World J Gastroenterol, 2012, 18(39): 5616-5621.
8.	Urschel JD, Urschel DM, Miller JD, et al. A meta-analysis of randomized controlled trials of route of reconstruction after esophagectomy for cancer. Am J Surg, 2001, 182(5): 470-475.
9.	Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst, 1993, 85(5): 365-376.
10.	Blazeby JM, Conroy T, Hammerlid E, et al. Clinical and psychometric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer. Eur J Cancer, 2003, 39(10): 1384-1394.
11.	Dantoc MM, Cox MR, Eslick GD. Does minimally invasive esophagectomy (MIE) provide for comparable oncologic outcomes to open techniques? A systematic review. J Gastrointest Surg, 2012, 16(3): 486-494.
12.	Akiyama H, Tsurumaru M, Udagawa H, et al. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg, 1994, 220(3): 364-372.
13.	Mannell A, McKnight A, Esser JD. Role of pyloroplasty in the retrosternal stomach: results of a prospective, randomized, controlled trial. Br J Surg, 1990, 77(1): 57-59.
14.	Chen H, Lu JJ, Zhou J, et al. Anterior versus posterior routes of reconstruction after esophagectomy: a comparative anatomic study. Ann Thorac Surg, 2009, 87(2): 400-404.
15.	Sarkaria IS, Rizk NP, Finley DJ, et al. Combined thoracoscopic and laparoscopic robotic-assisted minimally invasive esophagectomy using a four-arm platform: experience, technique and cautions during early procedure development. Eur J Cardiothorac Surg, 2013, 43(5): e107-e115.
16.	Suda K, Ishida Y, Kawamura Y, et al. Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes. World J Surg, 2012, 36(7): 1608-1616.
17.	Kim DJ, Park SY, Lee S, et al. Feasibility of a robot-assisted thoracoscopic lymphadenectomy along the recurrent laryngeal nerves in radical esophagectomy for esophageal squamous carcinoma. Surg Endosc, 2014, 28(6): 1866-1873.
18.	van Heijl M, Gooszen JA, Fockens P, et al. Risk factors for development of benign cervical strictures after esophagectomy. Ann Surg, 2010, 251(6): 1064-1069.
19.	De Boer AG, Genovesi PI, Sprangers MA, et al. Quality of life in long-term survivors after curative transhiatal oesophagectomy for oesophageal carcinoma. Br J Surg, 2000, 87(12): 1716-1721.
20.	Katsoulis IE, Robotis I, Kouraklis G, et al. Duodenogastric reflux after esophagectomy and gastric pull-up: the effect of the route of reconstruction. World J Surg, 2005, 29(2): 174-181.

1. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2): 69-90.
2. Ye B, Zhong CX, Yang Y, et al. Lymph node dissection in esophageal carcinoma: Minimally invasive esophagectomy versus open surgery. World J Gastroenterol, 2016, 22(19): 4750-4756.
3. Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg, 2012, 256(1): 95-103.
4. Osugi H, Takemura M, Higashino M, et al. A comparison of video-assisted thoracoscopic oesophagectomy and radical lymph node dissection for squamous cell cancer of the oesophagus with open operation. Br J Surg, 2003, 90(1): 108-113.
5. 冯明祥, 王群, 蒋伟, 等. 食管癌切除管状胃不同上提路径的比较. 中华胃肠外科杂志, 2010, 13(1): 33-35.
6. Anegg U, Lindenmann J, Maier A, et al. Influence of route of gastric transposition on oxygen supply at cervical oesophagogastric anastomoses. Br J Surg, 2008, 95(3): 344-349.
7. Zheng YZ, Dai SQ, Li W, et al. Comparison between different reconstruction routes in esophageal squamous cell carcinoma. World J Gastroenterol, 2012, 18(39): 5616-5621.
8. Urschel JD, Urschel DM, Miller JD, et al. A meta-analysis of randomized controlled trials of route of reconstruction after esophagectomy for cancer. Am J Surg, 2001, 182(5): 470-475.
9. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst, 1993, 85(5): 365-376.
10. Blazeby JM, Conroy T, Hammerlid E, et al. Clinical and psychometric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer. Eur J Cancer, 2003, 39(10): 1384-1394.
11. Dantoc MM, Cox MR, Eslick GD. Does minimally invasive esophagectomy (MIE) provide for comparable oncologic outcomes to open techniques? A systematic review. J Gastrointest Surg, 2012, 16(3): 486-494.
12. Akiyama H, Tsurumaru M, Udagawa H, et al. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg, 1994, 220(3): 364-372.
13. Mannell A, McKnight A, Esser JD. Role of pyloroplasty in the retrosternal stomach: results of a prospective, randomized, controlled trial. Br J Surg, 1990, 77(1): 57-59.
14. Chen H, Lu JJ, Zhou J, et al. Anterior versus posterior routes of reconstruction after esophagectomy: a comparative anatomic study. Ann Thorac Surg, 2009, 87(2): 400-404.
15. Sarkaria IS, Rizk NP, Finley DJ, et al. Combined thoracoscopic and laparoscopic robotic-assisted minimally invasive esophagectomy using a four-arm platform: experience, technique and cautions during early procedure development. Eur J Cardiothorac Surg, 2013, 43(5): e107-e115.
16. Suda K, Ishida Y, Kawamura Y, et al. Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes. World J Surg, 2012, 36(7): 1608-1616.
17. Kim DJ, Park SY, Lee S, et al. Feasibility of a robot-assisted thoracoscopic lymphadenectomy along the recurrent laryngeal nerves in radical esophagectomy for esophageal squamous carcinoma. Surg Endosc, 2014, 28(6): 1866-1873.
18. van Heijl M, Gooszen JA, Fockens P, et al. Risk factors for development of benign cervical strictures after esophagectomy. Ann Surg, 2010, 251(6): 1064-1069.
19. De Boer AG, Genovesi PI, Sprangers MA, et al. Quality of life in long-term survivors after curative transhiatal oesophagectomy for oesophageal carcinoma. Br J Surg, 2000, 87(12): 1716-1721.
20. Katsoulis IE, Robotis I, Kouraklis G, et al. Duodenogastric reflux after esophagectomy and gastric pull-up: the effect of the route of reconstruction. World J Surg, 2005, 29(2): 174-181.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of retrosternal versus posterior mediastinum approach for tubular stomach reconstruction on early surgical complications and short-term quality of life in patients with McKeown esophagectomy: A case control study

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