Evaluation of the Thoracic Inlet Area in Retrosternal Reconstruction of the Esophagus

Kimiyoshi Shimanuki, Michio Miyata, Masamitsu Shouji, Hiroyuki Shibusawa, Kuniyasu Souda, Toshihiro Kai, Hirokazu Kiyozaki, Masataka Satake, Yoshifumi Misumi, Takayoshi Yoshida

Department of Surgery, Jichi Medical School, Omiya Medical Center

Seventy-six esophageal cancer patients who underwent retrosternal reconstruction of the esophagus with gastric tube were studied. Esophagogastrostomy was performed with hand suturing in all patients. The patients were divided into two groups. Group A comprised 41 patients who had suture line leakage of the esophagogastrostomy. Group B comprised 35 patients without anastomotic dehiscence. We measured various factors of thoracic inlet space on computed tomography (CT) of these patients. Between groups A and B, there were significant differences in interclavicular distance (ICD), sterno-tracheal distance (STD), thoracic inlet area (TIA:=ICD×STD) and tracheal position ratio (TPR:=STD/SVD) values. Leakage at the esophagogastric anastomoses occurred in 81.0% of 21 cases whose TIA values were below 400 mm² and 66.7% of 45 cases whose TPR values were below 0.4. Narrow thoracic inlet space may badly influence on the healing of esophagogastric anastomosis. Preoperative evaluation of thoracic inlet space on cervico-thoracic CT provides important information to prevent anastomotic dehiscence.

Key words
thoracic inlet space, retrosternal reconstruction after esophagectomy, leakage of esophagogastrostomy

Reprint requests
Kimiyoshi Shimanuki The Department of Surgery, Jichi Medical School, Omiya Medical Center
1-847 Amanuma-cho, Omiya-shi, 330 JAPAN

Accepted
December 8, 1993

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