Fundus rotation gastroplasty vs. Kirschner-Akiyama gastric tube in esophageal resection:: Comparison of perioperative and long-term results

Background Improved tube length and low anastomotic leakage rates have been demonstrated for fundus rotation gastroplasty (FRG) after esophageal resection. The aim of the present study was to compare the safety of FRG vs. the conventional Kirschner-Akiyama gastric tube in a large prospective clinical series. Methods All patients with primary esophageal cancer who were to undergo esophageal resection at the authors' department were prospectively assessed. The subgroup of patients in whom FRG or the Kirschner-Akiyama reconstruction with either intrathoracic or cervical anastomosis was performed between October 2001 and November 2005 was analyzed for perioperative surgical and nonsurgical complications and for long-term survival. Results FRG was performed in 57 patients and Akiyama reconstruction was performed in 54 patients with potentially curative resectable carcinoma. The patients had a mean age of 60.3 years. Tumor type was squamous cell carcinoma in 51 patients and adenocarcinoma (AEG types I and II) in 60 patients. There were no differences between the reconstruction groups with respect to age, gender, tumor type, neoadjuvant treatment, and tumor stage. Duration of surgery, blood loss, resection margins, extent of lymphadenectomy, ICU stay, and hospital stay also did not show any significant differences. Overall leakage rate, including tube ischemia, was 9.9% and mortality was 2.7%. Compared with the Akiyama reconstruction, FRG was performed significantly more often in combination with cervical anastomosis (4 vs. 22, respectively, p = 0.0001). Uni- and multivariate analyses excluded the reconstruction type as a possible parameter for insufficiency. Furthermore, neither hospital mortality nor long-term survival was significantly different between the two groups. Conclusions This clinical series is the first to compare FRG and conventional gastric tube reconstruction after esophagectomy in esophageal cancer. With comparable perioperative and long-term results of either technique, the increased length of the FRG tube may have advantages for reconstruction with cervical anastomosis.