Abstract
ObjectiveThe optimal technique for the thoracoscopic construction of an intrathoracic esophagogastric anastomosis continues to be a subject of controversy. The aim of this study was to compare the perioperative outcomes of circular-stapled anastomosis using a transorally inserted anvil (Orvil™) with those of circular-stapled anastomosis using a transthoracically placed anvil (non-Orvil™) in totally minimally invasive Ivor Lewis esophagectomy (Ivor Lewis TMIE).MethodsThe data of 272 patients who underwent Ivor Lewis TMIE for esophageal cancer at multiple centers were collected from January 1, 2014 to December 31, 2017. After propensity score matching (1:1) for patient baseline characteristics, 65 paired cases were selected for statistical analysis. Logistic regression analysis was performed to investigate the significant factors of anastomotic leakage.ResultsIn the propensity score-matched analysis, compared with the non-Orvil™ group, the Orvil™ group was associated with a significantly shorter operation time (p=0.031), less intraoperative hemorrhage (p<0.001), lower need for intraoperative transfusions (p=0.009), earlier postoperative oral feeding time (p=0.010), longer chest tube duration (p<0.001), shorter postoperative hospital stays (p=0.001), lower total hospitalization costs (p<0.001) and a lower postoperative anastomotic leakage rate (p=0.033). Multivariate logistic regression analysis showed that anastomotic technique and pulmonary infection were independent factors for the development of postoperative anastomotic leakage (p< 0.05).ConclusionsOrvil™ anastomosis exhibited better perioperative effects than non-Orvil™ anastomosis after the propensity score-matched analysis. Remarkably, the Orvil™ technique contributed to a lower postoperative anastomotic leakage rate than the non-Orvil™ technique.
Highlights
Esophageal cancer is the sixth leading cause of cancer-related mortality among both men and women worldwide, accounting for approximately 5.5% of all cancer deaths worldwide in 2020 [1]
The postoperative hospital stays and the total hospitalization costs were less for the OrvilTM group than for the non-OrvilTM group (11 days versus 14 days, p=0.001, and 76,103.8 RMB versus 98,651.3 RMB, p
The results demonstrated that the postoperative anastomotic leakage rate was 1.79% in the OrvilTM group and the OrvilTM group showed a significantly lower incidence of anastomotic leakage, which was in line with the results reported previously [7, 21]
Summary
Esophageal cancer is the sixth leading cause of cancer-related mortality among both men and women worldwide, accounting for approximately 5.5% of all cancer deaths worldwide in 2020 [1]. Conventional technique for the transthoracic placement of the anvil (non-OrvilTM) is increasingly used for intrathoracic esophagogastric anastomosis. A retrospective study of 215 patients undergoing Ivor Lewis TMIE showed that the CS technique with purse-string suture is feasible and safe to perform, and the rate of postoperative anastomotic leakage was only 2.79% [5]. The design of the OrvilTM device is innovative and fundamentally transforms the conventional esophagogastric anastomotic technique; primarily, the thoracoscopic esophageal purse-string suture is replaced with a linear-stapled transected esophageal stump, and the anvil is placed transorally rather than transthoracically. The technique improved the technical feasibility and safety of esophagogastric anastomosis during Ivor Lewis TMIE, with preliminary results showing an anastomotic leakage rate of 2.7% [7]. A direct comparison between the OrvilTM CS technique and the non-
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