How important is the route of reconstruction after esophagectomy: A prospective randomized study

OBJECTIVE: A prospective randomized trial was performed to compare retroste rnal and posterior mediastinal gastric tube reconstruction with regard to p ostoperative function and quality of life. METHODS: Twenty-six patients were randomly allocated to either retrosternal (n = 14) or posterior mediastinal (n = 12) reconstruction after gastric tu be formation. Radionuclide transit studies were applied to obtain objective functional data and a standardized quality-of-life assessment was performe d. RESULTS: Retrosternal reconstruction showed an increased morbidity (15 vs 1 3 major complications) and mortality (14.2 vs 8.3%). Radionuclide clearance in the supine position was delayed in the gastric tube in general, compare d with normal controls (retention index > 40% vs < 10%). There was a signif icantly higher retention (p < 0.005) in the retrosternal group in the middl e third of the tube and the whole tube after intake of the liquid tracer. T he retention of the first solid tracer was also higher in the retrosternal group in the middle third of the tube (p = n.s.) and was significantly high er in the whole tube after 30 (p < 0.05) and 60 (p < 0.01) s. This had no s ignificant impact on the patients' quality of life. CONCLUSIONS: The posterior mediastinal route of reconstruction is recommend ed but curative resection (R0) is mandatory to avoid possible complications due to local tumor relapse. After incomplete resection (R1 or R2) we recom mend retrosternal reconstruction for better palliation. (Am J Gastroenterol 1999;94:1490-1496. (C) 1999 by Am. Coll. of Gastroenterology).