ANTERIOR VERSUS POSTERIOR RECONSTRUCTION AFTER TRANSHIATAL ESOPHAGECTOMY - A RANDOMIZED CONTROLLED TRIAL

In a prospective randomized trial the clinical results after transhiat al oesophagectomy with reconstruction in the anterior mediastinum (51 patients) or posterior mediastinum (45 patients) were compared. There were no differences in age, preoperative risk factors, tumour stage an d local (surgical) complications between the two groups. However, reco nstruction in the posterior mediastinum was associated with significan tly fewer days spent in the intensive therapy unit (9 versus 14), fewe r cardiopulmonary complications (13 versus 25 per cent) and lower mort ality (30-day mortality rate 2 versus 6 per cent; hospital mortality r ate 4 versus 10 per cent). These data show superiority of reconstructi on in the posterior mediastinum after transhiatal oesophagectomy. This route is strongly recommended, particularly for patients with cardiop ulmonary risk factors.