Conduit size and the risk of delayed gastric conduit emptying after esophagectomy

Delayed gastric conduit emptying (DGCE) is a frequent complication after esophagectomy that affects nutrition and the quality of life. Subtotal gastric conduit (STG) and wide gastric conduit (WG) reconstructions are commonly performed. This study assessed whether WG reduces DGCE compared to STG.

We retrospectively reviewed 169 patients who underwent posterior mediastinal gastric reconstruction between January 2019 and December 2024. Patients who underwent Ivor-Lewis procedures and non-gastric reconstructions were excluded. The conduits were classified as STG or WG based on the stapler firings. The resected gastric length and maximal diameter were measured. The outcomes included DGCE, anastomotic complications, pneumonia, weight loss, serum albumin, hemoglobin, and psoas muscle index (PMI). Appropriate statistical tests were performed.

Of the 169 patients, 128 underwent STG and 41 underwent WG reconstruction. The baseline characteristics were similar, although the WG group included more female patients and had a higher BMI. The resected gastric length was shorter in the STG (p < 0.001), whereas the conduit length tended to be longer (p = 0.051). No significant differences were observed in terms of DGCE, anastomotic leakage, pneumonia, weight loss, PMI, or albumin levels. Hemoglobin at 1 year was slightly lower in WG (10.2 vs. 11.1 g/dL, p = 0.002).

WG reconstruction did not reduce DGCE or other complications compared with STG reconstruction. The gastric conduit size alone may not prevent DGCE. Further studies are warranted to explore surgical strategies for improving postoperative gastric emptying.