Retrosternal tunnel creation using laparoscopy combined with modified cervical dissection in McKeown esophagectomy

In McKeown esophagectomy for cancer, esophageal reconstruction through the retrosternal (RS) route has many benefits; however, there are some concerns with this procedure. The application of laparoscopy combined with dissection behind the sternothyroid and sternohyoid muscles to create an RS tunnel is a promising technique.

A retrospective study comparing patients undergoing esophageal reconstruction through RS (RS group) and posterior mediastinal (PM) routes (PM group) was conducted at the Digestive Surgery Department, Cho Ray Hospital, Vietnam, from January 2016 to December 2023. The 2 groups of patients were matched by propensity score based on age, sex, body mass index, performance status, comorbidities, respiratory function, tumor location, pT stage, pN stage, level of lymphadenectomy, and types of anastomoses.

There were 335 patients; the RS group had 236 patients (70.4%) and the PM group had 99 patients (29.6%). After matching, each group had 99 patients. After matching, the 2 groups of patients were similar in patient characteristics, tumor location, tumor stage, level of lymphadenectomy, and types of anastomoses. The operating time of the RS group was significantly higher than that of the PM group (P <.001). Morbidity in the PM group was significantly higher than that in the RS group (P =.022). However, important complications were not statistically significant, such as pneumonia (P =.251), anastomotic leakage (P =.529), and hoarseness (P =.308). Mortality between the 2 groups was also not statistically significant (P =.497).

Laparoscopy combined with dissection behind the sternothyroid and sternohyoid muscles is a safe and efficient technique in the creation of an RS tunnel.