Anterior versus posterior routes of reconstruction after esophagectomy: a comparative anatomic study.

BACKGROUND: A gastric conduit is commonly used to reconstruct the alimentary tract after esophagectomy for esophageal cancer. The choice of anterior versus posterior route for reconstruction is debatable, and longer distance of the reconstructed routes may be associated with higher tension exerted on the transposed stomach. The aim of this study is to evaluate the length of both the anterior and posterior routes in a group of patients measured intraoperatively during esophagectomy for esophageal cancer.

METHODS: Sixty consecutive and nonselected patients with thoracic esophageal cancer were accrued in this prospective study. Measurements of the anterior (retrosternal) and posterior routes were performed after esophagectomy but before reconstruction with gastric conduit, from the cricoid cartilage to the pyloric ring.

RESULTS: The lengths of the anterior and posterior routes were 32.68 +/- 2.67 cm and 35.48 +/- 2.93 cm, respectively (p < 0.001). The anterior route is significantly shorter than the posterior route.

CONCLUSIONS: The anterior (retrosternal) route is the shorter passage for the reconstruction of the alimentary tract using the stomach after esophagectomy.