Randomized comparison of prevertebral and retrosternal gastric tube reconstruction after resection of oesophageal carcinoma

Background: After potentially curative resection of oesophageal cancer and prevertebral gastric tube reconstruction, approximately one-quarter of pati ents develop secondary dysphagia due to locoregional recurrence. In half of them dysphagia can be prevented by using an extra-anatomical reconstructio n route. The present randomized study was conducted to compare the technica l and functional results after prevertebral and retrosternal gastric tube r econstruction. Methods: Sixty patients underwent resection of a carcinoma of the oesophagu s or gastro-oesophageal junction with curative intent. Subsequently, these patients were randomly allocated to either prevertebral (n = 30) or retrost ernal (n = 30) gastric tube reconstruction. Early and late complications an d functional results were carefully monitored. Results: Creation of the retrosternal tunnel was not accompanied by any per ioperative complications. Postoperative recovery, anastomotic leakage and b enign stricture formation were not significantly different between the two groups. Functional results, as measured by scintigraphic gastric emptying, quantitative and qualitative oral food intake, and changes in body-weight w ere similar in the two groups. Conclusion: After subtotal oesophagectomy retrosternal gastric tube reconst ruction can be performed easily and safely, and gives functional results si milar to those obtained with prevertebral reconstruction In patients at hig h risk for developing secondary malignant dysphagia the extra-anatomical ro ute is the reconstruction of first choice.