ASO Author Reflections: Laparoscopic Retrosternal Route Creation after Minimally Invasive Esophagectomy is Associated with Good Reconstructed Conduit Function without Increasing Risk of Surgical Complications

概要

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ASO Author Reflections: Laparoscopic
Retrosternal Route Creation after Minimally
Invasive Esophagectomy is Associated with Good
Reconstructed Conduit Function without…
Increasing Risk of Surgical Complications

Horikawa, Manabu
Oshikiri, Taro
(Citation)
Annals of Surgical Oncology,30(7):4054-4055

(Issue Date)
2023-07

(Resource Type)
journal article

(Version)
Accepted Manuscript

(Rights)
This version of the article has been accepted for publication, after peer review (when
applicable) and is subject to Springer Nature's AM terms of use, but is not the
Version of Record and does not reflect post-acceptance improvements, or any
corrections. The Version of Record is available online at:…
https://doi.org/10.1245/s10434-023-13371-0
(URL)
https://hdl.handle.net/20.500.14094/0100481889

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ASO Author Reflections: Laparoscopic Retrosternal Route Creation after MIE

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is Associated with Good Reconstructed Conduit Function without Increasing

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Risk of Surgical Complications

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Authors and their affiliations:

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Manabu Horikawa,MD 1 , Taro Oshikiri,MD 1

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1. Division of Gastrointestinal Surgery, Department of Surgery, Graduate

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School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku,

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Kobe, Hyogo, 650-0017, Japan

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Address correspondence and reprint requests to:

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Taro Oshikiri, MD

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Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of

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Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-

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0017, Japan

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Telephone: +81-78-382-5925

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Fax: +81-78-382-5939

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E-mail: oshikiri@med.kobe-u.ac.jp

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Disclosures:

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Manabu Horikawa and Taro Oshikiri have no conflicts of interest or financial

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ties to disclose.

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Past

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The posterior mediastinal or retrosternal route is frequently employed for

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gastric conduit reconstruction after esophagectomy, each with its unique

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advantages

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characterized by a relatively straightforward reconstruction procedure and

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physiologically

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mediastinitis, 1 gastro-tracheal fistula, 2 and postoperative hiatal hernia. 3 In

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contrast, the retrosternal route circumvents such severe complications, albeit

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at the expense of dissection in the retrosternal space and the risk of pleural

and

disadvantages.

normal

food

The

flow,

posterior

but

poses

mediastinal

risks

such

route

as

is

severe

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injury and hemorrhage during the process.

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Previously, we reported on a novel laparoscopic retrosternal route creation

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(LRRC) technique to minimize these risks and the invasiveness of route

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creation. 4 However, it remains unclear whether LRRC reconstruction is non-

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inferior to posterior mediastinal reconstruction in terms of postoperative

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outcomes and reconstructed gastric conduit function.

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Present

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Our study results demonstrate that there were no significant differences in

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postoperative complications, including anastomotic leakage, between the

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retrosternal route reconstruction with LRRC and the posterior mediastinal

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reconstruction cohorts. However, the posterior mediastinal group had a higher

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incidence of gastro-tracheal fistula and postoperative hiatal hernia, which were

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avoided in the LRRC group. Notably, the LRRC group exhibited significantly

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better anastomotic reflux esophagitis outcomes on endoscopic evaluation one year

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postoperatively, despite no significant differences in anastomotic stenosis rates

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between the groups. Based on these results, we conclude that retrosternal route

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reconstruction after MIE using LRRC can be performed safely and with outcomes

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comparable to those of posterior mediastinal route reconstruction, and may result

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in favorable postoperative reconstructive gastric conduit function. 5

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9

Future

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This study presents a relatively small number of cases from a single

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institution. Therefore, to generalize the results, further research is necessary

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in the form of larger and more multicenter studies.

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Additionally, the relationship between the chosen reconstructive route and

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long-term prognosis requires further investigation and remains an important

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issue for future studies.

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1

Acknowledgements

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None.

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1

References

2

1.

Biere SSAY, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus

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open oesophagectomy for patients with oesophageal cancer: a multicentre, open-

4

label, randomised controlled trial. Lancet. 2012;379(9829):1887-1892.

5

2.

Yasuda T, Sugimura K, Yamasaki M, et al. Ten cases of gastro-tracheobronchial

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fistula: a serious complication after esophagectomy and reconstruction using

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posterior mediastinal gastric tube. Dis Esophagus. 2012;25(8):687-693.

8

3.

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Invasive Esophagectomy: A Systematic Review and Meta-analysis. Ann Surg Oncol.

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2016;23(8):2690-2698.
4.

12
13

Oor JE, Wiezer MJ, Hazebroek EJ. Hiatal Hernia After Open versus Minimally

Horikawa M, Oshikiri T, Takiguchi G, et al. Laparoscopic creation of a retrosternal
route for gastric conduit reconstruction. Surg Endosc. 2022;36(4):2680-2687.

5.

Horikawa M, Oshikiri T, Kato T, et al. Efficacy and Postoperative Outcomes of

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Laparoscopic Retrosternal Route Creation for the Gastric Conduit: Propensity

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Score–Matched Comparison to Posterior Mediastinal Reconstruction. Ann Surg

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Oncol. ...

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