Impact of the route of reconstruction on post-operative morbidity and malnutrition after esophagectomy: A multicenter cohort study

Makoto Yamasaki, Hiroshi Miyata, Takushi Yasuda, Osamu Shiraishi, Tsuyoshi Takahashi, Masaaki Motoori, Masahiko Yano, Hitoshi Shiozaki, Masaki Mori, Yuichiro Doki

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Reconstruction after esophagectomy is mainly performed through the retrosternum (RS) or posterior mediastinum (PM). However, the best approach is not clear. This study aimed to assess the impact of the route of gastric conduit reconstruction, after esophagectomy for esophageal squamous cell carcinoma (ESCC), on postoperative outcomes. Methods: We analyzed 298 patients who underwent radical esophagectomy for ESCC at three high volume centers between 2008 and 2009. Among them, the RS was selected in 166 patients and PM in 118; while, the antethoracic route was used in 14 patients. Post-operative morbidity, mortality, and long-term outcome were compared. Results: There were no differences between patients of the two routes with respect to operative blood loss (RS: 753 ± 519, PM: 748 ± 414 g) and post-operative complications, including pulmonary problems (RS: 15 %, PM: 10.2 %) and anastomotic leakage (RS: 9.0 %, PM: 5.1 %); although, the operating time (RS: 566 ± 97, PM: 472 ± 79 min; p < 0.0001) was shorter in the PM group than the RS group. The percentage weight loss after surgery was significantly less in the PM group than the RS group at 1 year (8.6 vs. 11.1 %; p = 0.025); although, the percentage at discharge was not different between the groups (PM: 4.9 %, RS: 6.3 %; p = 0.072). Multivariate analysis identified pre-operative body weight and the reconstruction route as significant and independent factors associated with 1-year weight loss. Conclusions: The results indicate gastric tube reconstruction through the posterior mediastinal route after esophagectomy may relieve post-operative 1-year malnutrition without increasing post-operative complications.

Original languageEnglish
Pages (from-to)433-440
Number of pages8
JournalWorld Journal of Surgery
Volume39
Issue number2
DOIs
Publication statusPublished - Jan 1 2015
Externally publishedYes

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Esophagectomy
Mediastinum
Malnutrition
Multicenter Studies
Cohort Studies
Morbidity
Weight Loss
Stomach
Anastomotic Leak
Multivariate Analysis
Body Weight
Lung
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery

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Impact of the route of reconstruction on post-operative morbidity and malnutrition after esophagectomy : A multicenter cohort study. / Yamasaki, Makoto; Miyata, Hiroshi; Yasuda, Takushi; Shiraishi, Osamu; Takahashi, Tsuyoshi; Motoori, Masaaki; Yano, Masahiko; Shiozaki, Hitoshi; Mori, Masaki; Doki, Yuichiro.

In: World Journal of Surgery, Vol. 39, No. 2, 01.01.2015, p. 433-440.

Research output: Contribution to journalArticle

Yamasaki, M, Miyata, H, Yasuda, T, Shiraishi, O, Takahashi, T, Motoori, M, Yano, M, Shiozaki, H, Mori, M & Doki, Y 2015, 'Impact of the route of reconstruction on post-operative morbidity and malnutrition after esophagectomy: A multicenter cohort study', World Journal of Surgery, vol. 39, no. 2, pp. 433-440. https://doi.org/10.1007/s00268-014-2819-1
Yamasaki, Makoto ; Miyata, Hiroshi ; Yasuda, Takushi ; Shiraishi, Osamu ; Takahashi, Tsuyoshi ; Motoori, Masaaki ; Yano, Masahiko ; Shiozaki, Hitoshi ; Mori, Masaki ; Doki, Yuichiro. / Impact of the route of reconstruction on post-operative morbidity and malnutrition after esophagectomy : A multicenter cohort study. In: World Journal of Surgery. 2015 ; Vol. 39, No. 2. pp. 433-440.
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abstract = "Background: Reconstruction after esophagectomy is mainly performed through the retrosternum (RS) or posterior mediastinum (PM). However, the best approach is not clear. This study aimed to assess the impact of the route of gastric conduit reconstruction, after esophagectomy for esophageal squamous cell carcinoma (ESCC), on postoperative outcomes. Methods: We analyzed 298 patients who underwent radical esophagectomy for ESCC at three high volume centers between 2008 and 2009. Among them, the RS was selected in 166 patients and PM in 118; while, the antethoracic route was used in 14 patients. Post-operative morbidity, mortality, and long-term outcome were compared. Results: There were no differences between patients of the two routes with respect to operative blood loss (RS: 753 ± 519, PM: 748 ± 414 g) and post-operative complications, including pulmonary problems (RS: 15 {\%}, PM: 10.2 {\%}) and anastomotic leakage (RS: 9.0 {\%}, PM: 5.1 {\%}); although, the operating time (RS: 566 ± 97, PM: 472 ± 79 min; p < 0.0001) was shorter in the PM group than the RS group. The percentage weight loss after surgery was significantly less in the PM group than the RS group at 1 year (8.6 vs. 11.1 {\%}; p = 0.025); although, the percentage at discharge was not different between the groups (PM: 4.9 {\%}, RS: 6.3 {\%}; p = 0.072). Multivariate analysis identified pre-operative body weight and the reconstruction route as significant and independent factors associated with 1-year weight loss. Conclusions: The results indicate gastric tube reconstruction through the posterior mediastinal route after esophagectomy may relieve post-operative 1-year malnutrition without increasing post-operative complications.",
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T1 - Impact of the route of reconstruction on post-operative morbidity and malnutrition after esophagectomy

T2 - A multicenter cohort study

AU - Yamasaki, Makoto

AU - Miyata, Hiroshi

AU - Yasuda, Takushi

AU - Shiraishi, Osamu

AU - Takahashi, Tsuyoshi

AU - Motoori, Masaaki

AU - Yano, Masahiko

AU - Shiozaki, Hitoshi

AU - Mori, Masaki

AU - Doki, Yuichiro

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background: Reconstruction after esophagectomy is mainly performed through the retrosternum (RS) or posterior mediastinum (PM). However, the best approach is not clear. This study aimed to assess the impact of the route of gastric conduit reconstruction, after esophagectomy for esophageal squamous cell carcinoma (ESCC), on postoperative outcomes. Methods: We analyzed 298 patients who underwent radical esophagectomy for ESCC at three high volume centers between 2008 and 2009. Among them, the RS was selected in 166 patients and PM in 118; while, the antethoracic route was used in 14 patients. Post-operative morbidity, mortality, and long-term outcome were compared. Results: There were no differences between patients of the two routes with respect to operative blood loss (RS: 753 ± 519, PM: 748 ± 414 g) and post-operative complications, including pulmonary problems (RS: 15 %, PM: 10.2 %) and anastomotic leakage (RS: 9.0 %, PM: 5.1 %); although, the operating time (RS: 566 ± 97, PM: 472 ± 79 min; p < 0.0001) was shorter in the PM group than the RS group. The percentage weight loss after surgery was significantly less in the PM group than the RS group at 1 year (8.6 vs. 11.1 %; p = 0.025); although, the percentage at discharge was not different between the groups (PM: 4.9 %, RS: 6.3 %; p = 0.072). Multivariate analysis identified pre-operative body weight and the reconstruction route as significant and independent factors associated with 1-year weight loss. Conclusions: The results indicate gastric tube reconstruction through the posterior mediastinal route after esophagectomy may relieve post-operative 1-year malnutrition without increasing post-operative complications.

AB - Background: Reconstruction after esophagectomy is mainly performed through the retrosternum (RS) or posterior mediastinum (PM). However, the best approach is not clear. This study aimed to assess the impact of the route of gastric conduit reconstruction, after esophagectomy for esophageal squamous cell carcinoma (ESCC), on postoperative outcomes. Methods: We analyzed 298 patients who underwent radical esophagectomy for ESCC at three high volume centers between 2008 and 2009. Among them, the RS was selected in 166 patients and PM in 118; while, the antethoracic route was used in 14 patients. Post-operative morbidity, mortality, and long-term outcome were compared. Results: There were no differences between patients of the two routes with respect to operative blood loss (RS: 753 ± 519, PM: 748 ± 414 g) and post-operative complications, including pulmonary problems (RS: 15 %, PM: 10.2 %) and anastomotic leakage (RS: 9.0 %, PM: 5.1 %); although, the operating time (RS: 566 ± 97, PM: 472 ± 79 min; p < 0.0001) was shorter in the PM group than the RS group. The percentage weight loss after surgery was significantly less in the PM group than the RS group at 1 year (8.6 vs. 11.1 %; p = 0.025); although, the percentage at discharge was not different between the groups (PM: 4.9 %, RS: 6.3 %; p = 0.072). Multivariate analysis identified pre-operative body weight and the reconstruction route as significant and independent factors associated with 1-year weight loss. Conclusions: The results indicate gastric tube reconstruction through the posterior mediastinal route after esophagectomy may relieve post-operative 1-year malnutrition without increasing post-operative complications.

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