Comparison of wide and narrow gastric conduit in esophageal cancer surgery

Sep 29, 2026

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Gastric conduit reconstruction is a common approach for esophageal reconstruction, yet complications such as anastomotic leakage and strictures persist. This study compared outcomes of narrow versus wide gastric conduit formation after esophagectomy. A retrospective cohort of 493 patients (2010–2019) from Taichung Veterans General Hospital evaluated two stapling strategies, with propensity score matching used for balanced comparisons. Narrow conduit showed lower leakage, hospital stay, and ICU outcomes. Postoperative dilatation was more common in the wide group, and univariate risk factors were not confirmed in multivariate analysis.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

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Abstract

1. Introduction

2. Methods

Study population and exclusions

Gastric conduit creation methods

Outcomes and analysis

J Chin MedAssoc Original article Comparison of wide and narrow gastric conduit in esophageal cancer surgery Yi-Wen Chena, Cheng-Yen Chuanga, Shyh-Sheng Yanga, Sen-Ei Shaia, Ming-Ching Leea, Hao-Yun Chena, Chih-Hung Lina,* aDivision of Thoracic Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC Abstract Background: Gastric conduit is most widely used method for esophageal reconstruction. Despite its popularity, certain complications, such as anastomotic leakage and strictures, remain to be resolved. In the present study, we reviewed the outcomes of narrow gastric conduit compared to wide gastric conduit reconstruction. Methods: We retrospectively reviewed 493 patients with esophageal cancer who received esophagectomy with reconstruction in Taichung Veteran General Hospital, Taiwan between January 2010 and December 2019. We performed gastric conduit reconstruction with two different methods, narrow gastric conduit made of multistaples (more than four staples) and wide gastric conduit made of two or three staples. Among the 493 patients, 170 patients underwent wide gastric conduit formation and 323 patients underwent narrow gastric conduit. After propensity score matching, 140 patients from each group were matched by 1:1 . Results: The average anastomotic leakage rate is 80 of 493 (16 .23%) . The leakage rate, length of hospital stay, intensive care unit (ICU) admission, and ICU stay were significantly lower in the narrow gastric conduit group than in the wide gastric conduit group. The need for postoperation dilatation was significantly higher in wide gastric conduit group (19 .41% vs 11.76%, p = 0.0217), and the time to first dilatation was similar in both groups (p = 0 .9808) . Similar results were observed even after propensity score matching. In univariate analysis, the narrow gastric conduit, circular stapler, video-assisted thoracic surgery, and laparoscopic surgery were associated with a reduced risk of anastomotic leakage. However, these factors are not statistically significant in a multivariate logistic regression analysis. Conclusion: The narrow gastric conduit is not inferior to the wide gastric conduit and can be considered an alternative option for gastric conduit preparation. Keywords: Anastomotic leakage; Dilatation; Esophagectomy; Propensity score; Veterans 1. INTRODUCTION Esophageal reconstruction is a crucial step during esophagectomy. Anastomotic leakage is a common complication after reconstruction and will result in great morbidity. Choices for reconstruction include the stomach, small intestine, and colon. The gastric conduit compared with the jejunum flap or colon interposition, has lower leakage rate because of less surgical complexity and fewer number of anastomosis and therefore are more widely used.1 Some studies have shown fewer postoperative digestive tract complications, earlier recovery, and a better quality of life when patients received gastric conduit reconstruction.2 The right gastric and gastroepiploic arteries are generally preserved for the gastric conduit.3,4 Creating an ideal gastric conduit is crucial because the blood supply may not be able to reach the anastomotic site, thus resulting in leakage, fistula, and even graft necrosis. Anastomotic leakage results in * Address correspondence. Dr. Chih-Hung Lin, Department of Surgery, Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Taichung 407, Taiwan, [ROC. E-mail address: sphenoidlin@gmail.com](ROC. E-mail address: sphenoidlin@gmail.com) (C.-H. Lin). Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2023) 86: 1074-1082. Received May 6, 2023; accepted August 29, 2023. doi: 10. 1097/JCMA.0000000000001004 Copyright © 2023, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND li

FAQs

What is the purpose of comparing narrow and wide gastric conduits in esophageal cancer surgery?

The study aims to evaluate whether narrow gastric conduit formation has comparable or better outcomes than wide conduit reconstruction, particularly regarding anastomotic leakage and related complications.

How were narrow and wide gastric conduits defined in the study?

Narrow gastric conduit was made using multistaples with more than four staples, while wide gastric conduit used two or three staples during reconstruction.

What were the key outcome differences between the narrow and wide groups?

The narrow group had significantly lower anastomotic leakage rate, shorter hospital stay, and reduced ICU admission and ICU stay. Wide conduit required postoperative dilatation more often, while the time to first dilatation was similar between groups.

Sep 29, 2026

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