Abstract
BackgroundAnastomosis is one of the important factors affecting anastomotic complications after esophagectomy, and multiple reports have compared anastomotic complications among various techniques. However, there is insufficient evidence in the literature to definitively recommend one anastomotic technique over another.MethodWe retrospectively evaluated 34 consecutive patients who underwent an improved totally mechanical side‐to‐side: posterior‐to‐posterior linear stapled (TM‐STS) technique for minimally invasive Ivor Lewis esophagogastric anastomosis, performed by a single surgeon between February 2015 to November 2017. The operative techniques and short‐term outcomes are analyzed in this study.ResultsThere were no conversions to an open approach and a complete resection was achieved in all patients undergoing this improved procedure. During the first half of the series, the median operation time was 355 minutes, ranging from 257 to 480 minutes. Over the second half of this series, the median operation time was reduced to 256 minutes. There were no mortalities or serious postoperative complications. Only one patient (2.9%) had an anastomotic leak, which resolved without intervention. Another patient (2.9%) experienced transient, delayed conduit emptying which upper gastrointestinal radiography determined was due to a mechanical obstruction caused by an abnormally long gastric tube in the chest cavity.ConclusionsThe results of our study suggest that this improved TM‐STS technique is safe and effective for minimally invasive Ivor Lewis esophagectomy, and can be considered as one of the alternative procedure for patients with lower esophageal as well as Siewert types I/II gastroesophageal junction carcinoma.
Highlights
For over a century, esophagectomy has been the mainstay of curative treatment for esophageal cancer
We have developed an improved “totally mechanical side-to-side: posterior-to-posterior linear stapled” (TM-STS) technique for minimally invasive Ivor Lewis (MIE-IL) esophagogastric anastomosis, designed to offer a wider anastomotic diameter and fewer morbidities associated with anastomotic leaks and strictures, and technical simplicity in constructing an intrathoracic esophagogastric anastomosis
Informed consent was signed by all 34 patients or their legal representatives regarding the scientific use of collected data, including data from their medical records, obtained while undergoing a minimally invasive esophagectomy (MIE)-IL esophagectomy using an TMSTS esophagogastric anastomosis from February 2015 to November 2017
Summary
Esophagectomy has been the mainstay of curative treatment for esophageal cancer. A significant number of patients have experienced long-term survival following an esophagectomy for early-stage esophageal cancer with low operative mortality.[1] Due to the widespread application of neoadjuvant chemoradiotherapy as well as improvement of thoracoscopic surgical devices and techniques, minimally invasive esophagectomy (MIE) is increasingly being used to resect esophageal cancers.[2] The development of minimally invasive esophageal surgery has accelerated and improved the rehabilitation of patients, reduced postoperative complications and mortality, and resulted in long-term survivors.[3] analogous to. Conclusions: The results of our study suggest that this improved TM-STS technique is safe and effective for minimally invasive Ivor Lewis esophagectomy, and can be considered as one of the alternative procedure for patients with lower esophageal as well as Siewert types I/II gastroesophageal junction carcinoma
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