Is anterior mediastinum route a shorter choice for esophageal reconstruction? A comparative anatomic study

Objective: The reconstruction of the alimentary tract after esophagectomy is usually achieved by either anterior or posterior route through the mediastinum. Previous anatomic studies in comparing the length of both routes applied different methods and yielded inconsistent results. In order to resolve this important debate, we went back to cadavers to clarify the anatomic truth. Methods: With strictly defined anatomic models, the distance of both routes between the proximal reference point (the cricoid cartilage) and the distal reference points (the celiac axis, the gastroduodenal artery, and the pyloric ring) was obtained on 20 cadavers. Results: The length of the anterior route was significantly longer than the posterior route using the celiac axis (34.9 +/- 2.5 vs 32.4 +/- 2.3 cm, P < 0.0001), but was significantly shorter using either the gastroduodenal artery (35.4 +/- 2.6 vs 36.7 +/- 2.7 cm, P = 0.0177) or the pyloric ring (34.9 +/- 2.8 vs 36.4 +/- 2.9 cm, P = 0.0168) as the distal reference point which is more clinically relevant. Conclusions: Compared with the posterior route, the anterior route may be considered as a shorter choice for the conduit to reach the cervical region for esophageal reconstruction. (C) 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.