Modified reverse-puncture anastomotic technique vs. traditional technique for total minimally invasive Ivor-Lewis esophagectomy

Xiaokang Shen,Tianming Chen,Ming Zheng,Peng Lu,Zhang Yan Zhou,Po Yang,Shilin Chen,Jiawei Zhao,Hai Tao Qiu,Xiaoming Shi

doi:10.1186/s12957-020-02093-2

Abstract

BackgroundTotal endoscopic Ivor-Lewis esophagectomy is a challenging, complex, and costly operation. These disadvantages restrict its wide application. The aim of this study was to compare the modified reverse-puncture anastomotic technique and traditional technique for total minimally invasive Ivor-Lewis esophagectomy.MethodsIn this cohort retrospective study, all patients with medial and lower squamous cell carcinoma of esophagus from February 2014 and June 2018 were divided into two groups according to the surgical method, which were modified reverse-puncture anastomotic technique group and traditional technique group. The operation time, intraoperative bleeding volume, complications, and cost of the two groups were compared.ResultsForty-eight patients in the modified reverse-puncture anastomotic technique group while 54 patients in the traditional technique group were included. The operation time was 293.4 ± 57.2 min in the modified reverse-puncture anastomotic technique group, which was significantly shorter than that in the traditional technique group (353.4 ± 64.1 min) (P < 0.05). The intraoperative bleeding volume of modified reverse-puncture anastomotic technique group was 157.3 ± 107.4 ml, while it was 191.9 ± 123.6 ml in traditional technique group (P = 0.14). There were similar complications between the two groups. The cost of modified reverse-puncture anastomotic and traditional technique in our hospital were and 72 ± 13 and 83 ± 41 thousand Yuan, respectively (P = 0.08).ConclusionThe good short-term outcomes that were achieved suggested that the use of modified reverse-puncture anastomotic technique is safe and feasible for total endoscopic Ivor-Lewis esophagectomy.

Highlights

It is reported that the esophageal cancer ranks the third of incidence of malignant tumors and fourth of mortality in China, which seriously threatens the health of the Chinese people [1]
In this report, based on our experience in 48 total endoscopic Ivor-Lewis esophagectomy, we described a thoracoscopic anastomosis using a common stapler with reverse-puncture anastomosis technique, which achieved good results
Basic characteristics Medical records from 48 patients (34 males and 14 females) with medial and lower esophageal cancer were retrospectively included in modified reverse-puncture anastomotic technique group

Summary

Introduction

It is reported that the esophageal cancer ranks the third of incidence of malignant tumors and fourth of mortality in China, which seriously threatens the health of the Chinese people [1]. Modified reversepuncture anastomotic technique is based on a new idea for completely intracorporeal anastomosis combined with transanal specimen extraction, and the procedure can be performed. This technique has more commonly been reported to be applied in laparoscopic gastric cancer surgery [4, 5]. This study was to compare the modified reverse-puncture anastomotic technique and traditional technique for total minimally invasive Ivor-Lewis esophagectomy. In this report, based on our experience in 48 total endoscopic Ivor-Lewis esophagectomy, we described a thoracoscopic anastomosis using a common stapler with reverse-puncture anastomosis technique, which achieved good results. The aim of this study was to compare the modified reverse-puncture anastomotic technique and traditional technique for total minimally invasive Ivor-Lewis esophagectomy

Objectives

Methods

Results