{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T07:44:18Z","timestamp":1792136658352,"version":"4.4.0"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":256,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Asian J Endoscop Surgery"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Anastomotic leakage (AL) after esophagectomy increases morbidity and mortality. Although mediastinal anatomy has been implicated in AL, no prior study has evaluated this issue in transcervical\u2013hiatal subtotal esophagectomy (closed mediastinum). We investigated whether the scaled upper mediastinal anteroposterior diameter (sAPD) and anastomotic height (AH) influence AL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively studied 224 patients who underwent transcervical\u2013hiatal subtotal esophagectomy with mediastinoscopy\u2010assisted mediastinal lymphadenectomy and posterior mediastinal reconstruction using a subtotal gastric conduit; the pleura was preserved (closed mediastinum). sAPD was measured on preoperative CT and AH on the first postoperative CT obtained 3\u20136\u2009months postoperatively. Associations with AL were assessed by logistic regression, and receiver operating characteristic (ROC)\u2010derived cutoffs defined four sAPD\u2009\u00d7\u2009AH risk groups. Two comparison cohorts (transthoracic,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200991; narrow gastric conduit,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200920) were also analyzed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      AL occurred in 31\/224 (13.8%). Narrower sAPD and higher AH were independently associated with AL (odds ratio [OR] 0.86,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002; OR 1.15,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.049); risk was highest in the narrow\u2010sAPD\/high\u2010AH group (35.9%; OR 12.32). Airway\u2010gastric fistula occurred in five patients (2.2%), all with a narrow sAPD. AH alone was associated with AL in the transthoracic cohort; AL was 5.0% in the narrow gastric conduit cohort.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>sAPD and AH are practical, imaging\u2010based predictors of AL after transcervical\u2013hiatal subtotal esophagectomy. The association between narrow sAPD and airway\u2010gastric fistula supports conduit\u2013space mismatch as a mechanism. Combined assessment stratifies risk and may guide conduit design and anastomotic level.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ases.70378","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T23:36:34Z","timestamp":1789428994000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Upper Mediastinal Anatomy and Anastomotic Position on Anastomotic Leakage After Transcervical\u2013Hiatal Subtotal Esophagectomy With Posterior Mediastinal Reconstruction"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6011-4630","authenticated-orcid":false,"given":"Akihiro","family":"Kuroda","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal Surgery, Graduate School of Medicine The University of Tokyo  Bunkyo\u2010ku Tokyo 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University of Tokyo  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asami","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Graduate School of Medicine The University of Tokyo  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7532-4072","authenticated-orcid":false,"given":"Shuichiro","family":"Oya","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Graduate School of Medicine The University of Tokyo  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyuki","family":"Miwa","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Graduate School of Medicine The University of Tokyo  Bunkyo\u2010ku Tokyo 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