BACKGROUND: A choice of retrosternal or orthotopic route for reconstruction exists after three-phase esophagectomy with cervical @entity254 . Whether the route of reconstruction affects postoperative morbidity, mortality and recurrence patterns remains controversial. STUDY DESIGN: @entity1 with @entity5 of the thoracic esophagus who underwent three-phase esophagectomy between 1990 and 1999 were studied. Postoperative outcome, recurrence patterns and survival were analyzed from a prospectively collected database. RESULTS: Seventy-five @entity1 underwent three-phase esophagectomy. There were 46 @entity1 in the retrosternal group and 29 in the orthotopic group. The mean age of the retrosternal group was younger than the orthotopic group, 60 and 66 years, respectively (p = 0.004). The retrosternal group also had more advanced disease; 24% of @entity1 had curative resection compared with 59% in the orthotopic group (p = 0.003). There was no significant difference in postoperative complications except that the retrosternal group had more @entity190 , median 800 ml compared with 700 ml (p = 0.04). Hospital mortality was 13% in the retrosternal group and 3.4% in the orthotopic group (p = 0.24). Multivariate analysis showed that age (odds ratio 1.16, p = 0.035) and pulmonary risk (odds ratio 10, p = 0.01) were predictive of hospital mortality, but not the route of reconstruction. No @entity1 in the retrosternal group developed recurrence in the gastric conduit compared to 4 of 28 @entity1 (14%) in the orthotopic group (p = 0.03). Two of these @entity1 were symptomatic with bleeding from the intragastric recurrence. Survival was worse in the retrosternal group, 5-year survival was 29.8 vs. 8.2% (p < 0.01), reflecting the more advanced disease and higher prevalence of palliative resections. CONCLUSIONS: Cardiopulmonary complications and hospital mortality were not significantly different in the two groups. @entity5 infiltration of the gastric conduit occurred in 14% of @entity1 when the orthotopic route was used.

Influence of the route of reconstruction on morbidity, mortality and local recurrence after esophagectomy for XXXX .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity254 :: ('MESH:C563598', 'Disease') :: ['anastomosis'] @entity190 :: ('MESH:D006473', 'Disease') :: ['blood loss'] @entity5 :: ('MESH:D009369', 'Disease') :: ['Recurrent tumor', 'cancer']
@entity5 :: (MESH:D009369,Disease) :: ['cancer']
