Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 21, 2012; 18(39): 5616-5621
Published online Oct 21, 2012. doi: 10.3748/wjg.v18.i39.5616
Comparison between different reconstruction routes in esophageal squamous cell carcinoma
Yu-Zhen Zheng, Shu-Qin Dai, Wei Li, Xun Cao, Xin Wang, Jian-Hua Fu, Peng Lin, Lan-Jun Zhang, Bin Lu, Jun-Ye Wang
Yu-Zhen Zheng, Xun Cao, Xin Wang, Jian-Hua Fu, Peng Lin, Lan-Jun Zhang, Bin Lu, Jun-Ye Wang, Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Shu-Qin Dai, Department of Clinical Laboratory, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Wei Li, Department of Anesthesia, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Author contributions: Zheng YZ and Dai SQ contributed equally to this work; Zheng YZ and Dai SQ drafted the article; Li W and Cao X revised the manuscript; Wang X, Fu JH and Lin P provided the raw data; Zhang LJ and Lu B analyzed the data; and Wang JY designed the study.
Supported by Science and Technology Project of Guangdong Province, China, No. 2010B031600220 and 2008B030303008
Correspondence to: Jun-Ye Wang, Professor, Department of Thoracic Oncology, Cancer Center, Sun Yat-Sen University, No.651, Dongfeng Road East, Guangzhou 510060, Guangdong Province, China. zhengyzh@sysucc.org.cn
Telephone: +86-20-87343315 Fax: +86-20-87343268
Received: March 28, 2012
Revised: August 22, 2012
Accepted: August 26, 2012
Published online: October 21, 2012
Abstract

AIM: To compare postoperative complications and prognosis of esophageal squamous cell carcinoma patients treated with different routes of reconstruction.

METHODS: After obtaining approval from the Medical Ethics Committee of the Sun Yat-Sen University Cancer Center, we retrospectively reviewed data from 306 consecutive patients with histologically diagnosed esophageal squamous cell carcinoma who were treated between 2001 and 2011. All patients underwent radical McKeown-type esophagectomy with at least two-field lymphadenectomy. Regular follow-up was performed in our outpatient department. Postoperative complications and long-term survival were analyzed by treatment modality, baseline patient characteristics, and operative procedure. Data from patients treated via the retrosternal and posterior mediastinal routes were compared.

RESULTS: The posterior mediastinal and retrosternal reconstruction routes were employed in 120 and 186 patients, respectively. Pulmonary complications were the most common complications experienced during the postoperative period (46.1% of all patients; 141/306). Compared to the retrosternal route, the posterior mediastinal reconstruction route was associated with a lower incidence of anastomotic stricture (15.8% vs 27.4%, P = 0.018) and less surgical bleeding (242.8 ± 114.2 mL vs 308.2 ± 168.4 mL, P < 0.001). The median survival time was 26.8 mo (range: 1.6-116.1 mo). Upon uni/multivariate analysis, a lower preoperative albumin level (P = 0.009) and a more advanced pathological stage (pT; P = 0.006; pN; P < 0.001) were identified as independent factors predicting poor prognosis. The reconstruction route did not influence prognosis (P = 0.477).

CONCLUSION: The posterior mediastinal route of reconstruction reduces incidence of postoperative complications but does not affect survival. This route is recommended for resectable esophageal squamous cell carcinoma.

Keywords: Esophageal carcinoma; Route of reconstruction; Posterior mediastinal; Retrosternal; Comparison