Quality of palliation and possible benefit of extra-anatomic reconstruction in recurrent XXXX after resection of @entity189 .

@entity1 @entity5 @entity254 @entity189 @entity344 @entity25271 @entity3121 @entity1282
BACKGROUND: After "curative" resection of @entity189 , late secondary @entity1282 almost invariably indicates @entity5 recurrence. The retrosternal reconstruction route is advocated to prevent ingrowth of @entity5 recurrence in the neoesophagus. STUDY DESIGN: To evaluate the quality of palliation after "curative" resection of @entity189 and the possible benefit of the retrosternal reconstruction route, we retrospectively analyzed the records of @entity1 who had resection of a @entity5 , or the gastroesophageal junction, and a prevertebral reconstruction. The extra-anatomic route would have been only beneficial for @entity1 with intrathoracic @entity5 recurrence distant from the @entity254 and causing @entity344 . RESULTS: Between 1983 and 1989, 209 @entity1 (mean age of 61.3 years at the time of operation) had "curative" resection and prevertebral reconstruction in the institution of this study. Seventy-three @entity1 (35 percent) had @entity5 recurrence. Univariate and multivariate analysis of various risk factors for locoregional recurrence showed that the presence of positive lymph nodes ( @entity3121 ), especially if located at the celiac trunk ( @entity25271 ), and a macroscopically non-radical R2 resection were the most important risk factors. Forty-six @entity1 (22 percent) had secondary @entity1282 as a result of @entity5 recurrence, mostly (18 percent) within two years postoperatively. @entity1282 lasted on average 5.3 months (range of 0.3 to 21.5 months) before the @entity1 died. In 27 @entity1 (13 percent), @entity1282 would probably have been prevented by using a retrosternal reconstruction route. CONCLUSIONS: These data are an argument in favor of the extra-anatomic, retrosternal reconstruction route after limited transthoracic or transhiatal resection in the presence of positive lymph nodes. This method seems especially indicated if the nodes are located at the celiac trunk and in case of a macroscopically nonradical R2 resection.
