PS02.015: EXPERIENCES OF COMPLETE LAPARO-THORACOSCOPIC MINIMALLY INVASIVE ESOPHAGECTOMY WITH SIDE-TO-SIDE ESOPHAGOGASTROSTOMY

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Abstract Background Recently minimally invasive esophagectomy (MIE) has become more common over the world. Since 2014 we applied the laparo-thoracoscopic minimally invasive esophagectomy with intrathoracic side-to-side esophagogastrostomy. In this study, we present our experiences of minimally invasive Ivor-Lewis (IL) technique. Methods In succession to laparoscopic abdominal operation with upper abdominal lymphadenectomy and formation of the gastric tube conduit, patients were turned to prone position. After middle and lower mediastinal lymphadenectomy, the gastric conduits were pulled up to the chest through the hiatus and the specimens were removed. The side-to-side anastomoses were done using linear triple stapler and the defects were closed with thoracoscopic suturing. The outcomes of minimally invasive IL during 2014–2018 have been compared with those of open IL for esophageal adenocarcinoma. Results Among 279 patients with esophagectomy a minimally invasive IL was done in 118 3 cases (2.5%) were converted to open technique due to technical or oncological reasons. There were no significant differences in age, sex, BMI and ASA score at baseline. In the MIE group the peroperative blood loss and operation time was reduced 100 ml vs 550 ml (P < 0.01), and 395 min vs 420 min (P < 0.01). The numbers of harvested lymph nodes were superior in MIE group: 33 vs 23 (P < 0.01). Although there were no significant differences in the incidence of postoperative complication rate (36% vs 38%) and leakage rate (20% vs 16%), 1-year and 3-year overall survival rate were significantly better in MIE group (0.76 and 0.63, respectively (P = 0.01) as compared to open procedure (0.73 and 0.42, respectively) (P = 0.01). MIE was proven to be an independent factor for better prognosis in a Cox regression analysis. Conclusion Our minimally invasive Ivor-Lewis esophagectomy technique is feasible and might achieve better prognosis. Future research has to provide further evidence whether the method can minimize the risk and severity of postoperative complications including anastomotic leakages and improve survival. Disclosure All authors have declared no conflicts of interest.