An individual's physique is associated with the length of the reconstruction route via the retrosternal approach.

Abstract

We hypothesized that an individual's physique is related to reconstruction length, as organs reconstructed via the retrosternal route are curved toward the ventral side. This study aimed to determine factors contributing to the reconstruction length of the retrosternal route. Fifty patients underwent subtotal esophagectomy with esophagogastric reconstruction via the posterior mediastinal route between 2010 and 2014; the esophagus-stomach and posterior mediastinal route lengths were measured to evaluate whether they could be approximated. Forty patients underwent reconstruction via the retrosternal route between 2015 and 2020; the esophagus-stomach and retrosternal route lengths were compared, and contributing factors were analyzed. Each length was measured perioperatively using three-dimensional enhanced computed tomography images. The associated factors obtained included age, sex, height, body weight, body mass index, thickness and height of the thorax, depth of the thoracic inlet space, thoracic curve, left hepatic lobe volume, and the thickness and height of the liver. The length of the esophagus-stomach could approximate that of the posterior mediastinal route [posterior mediastinal-esophagus-stomach; 0.04 (-0.5-0.6) cm, p = 0.77]. Using three-dimensional enhanced computed tomography images, the lengths of the esophagus-stomach and retrosternal routes were comparable, despite variability [retrosternal-esophagus-stomach; 0.72 (-0.1-1.8) cm, p = 0.095]. Analyzing factors associated with the length revealed a positive correlation of body weight, body mass index, and thickness of the thorax with the difference. A higher body mass index (OR = 1.7, 95% CI 1.1-2.8, p = 0.007) was associated with a longer retrosternal route in the multivariate analysis. An individual's physique is associated with the reconstruction length; particularly, the length of the retrosternal route was longer in patients with a high body mass index.