Objective  To investigate the effect and mechanism of thoracic gastric tube and posterior mediastinal gastric tube formation on cardiopulmonary complications in patients who underwent minimally invasive McKeown surgery for esophageal carcinoma.

  Methods  This retrospective cohort study included 697 patients with esophageal carcinoma who underwent minimally invasive McKeown surgery in The First Affiliated Hospital of Zhengzhou University from December 2017 to September 2020. Based on postoperative chest computed tomography data, the following two groups were defined: thoracic gastric tube (tubular stomach partially or completely located in the thoracic cavity) and posterior mediastinal gastric tube (tubular stomach located in the posterior mediastinal esophageal bed). To assess the formation mechanism of two types of tubular stomach after minimally invasive Mckeown surgery and examine their relationship with cardiopulmonary complications, comparative analysis of general clinical features, operation-related variables, and incidence of postoperative cardiopulmonary complications was performed between the two groups.

  Results  Comparison of operative variables between the two groups revealed that the gastrectomy area was larger in the posterior mediastinal gastric tube group than in the thoracic gastric tube group (65.7±38.2) \mathrmc\mathrmm^2 vs. (55.0±31.7) \mathrm \mathrmc\mathrmm^2 , P<0.001, and the width of the tubular stomach (3.3±0.7) cm vs. (4.1±1.1) \mathrmc\mathrmm , P<0.001 and the stomach-chest ratio (i.e., the ratio of tubular gastric width to thoracic width) (0.30±0.1) vs. (0.39±0.1), P<0.001 were smaller in the posterior mediastinal gastric tube group than in the thoracic gastric tube group. The incidence of postoperative complications was lower in the posterior mediastinal gastric tube group than in the thoracic gastric tube group, and the incidences of atelectas is (36.0% vs. 54.2%, P<0.001), pleural effusion (40.7% vs. 53.8%, P=0.001), and cardiovascular complications (16.0% vs. 22.3%, P=0.042) were lower in the posterior mediastinal gastric tube group than in the thoracic gastric tube group. However, there were no significant differences between the two groups with respect to the incidence and general clinical characteristics of pneumothorax, subcutaneous pneumothorax, respiratory failure, anastomotic fistula, anastomotic stenosis (P>0.05).

  Conclusions  During minimally invasive McKeown surgery for esophageal carcinoma, the formation of posterior mediastinal gastric tube can reduce the incidence of atelectasis, pleural effusion, and cardiovascular complications. The gastrectomy area is related to the formation of two types of tubular stomach, and posterior mediastinal gastric tube is more likely to be formed when the gastrectomy area is larger.