Abstract
Objective To explore the feasibility and short-term efficacy of laparoscopic and thoracoscopic Ivor Lewis esophagectomy using a circular-stapled anastomosis with trans-oral anvil in treating esophageal carcinoma.Methods 30 consecutive patients with esophageal cancer received minimally invasive Ivor Lewis esophagectomy from January 2011 to December 2011.Operations of all the cases comprised of both abdominal and thoracic procedures which were performed with Iaparoscopic and thoracoscopic techniques respectively.The intrathoracic esophago-gastric anastomosis was created using a circular-stapled anastomosis with trans-oral anvil technique.Results There were 24 males and 6 female with median age of 62.5-year-old (from 47 to 82).The lesions located in middle and/or lower portion of the esophagus.25 patients with esophageal squamous cell cancer (n =25) and 5 patients with adenocarcinoma (n =5) underwent an Ivor Lewis esophagectomy.All the operations were successfully performed without intra-operative technical failures of the anastomosis or deaths.The mean operation time was 95 minutes in abdomen and 177 minutes in thorax.The mean blood loss was 310 ml.The mean number of harvested lymph nodes was 10.6 from thorax and 4.9 from abdomen.Postoperalively,there were thoracic wound infections in 4 patients.One patient had a left diaphragmatic hernia and was successfully treated by re-operation 6 days after first operation.One patient had chylothorax and recovered without surgery.There was no anastomotic leak and the patients were able to have spoon meat at 5.6 postoperative days.Conclusion Laparoscopic and thoracoscopic Ivor Lewis esophagectomy can be accomplished smoothly with acceptable occurrence of complications.The circular-stapled anastomosis with the trans-oral anvil is an efficient,safe and reproducible technique for intrathoracic esophago-gastric anastomosis. Key words: Esophageal carcinomas; Ivor Lewis esophagectomy, Thoracoscopy; Laparoscopy; Esophago-gastiic; anastomosis
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