USE OF PEG SITE FOR SPECIMEN RETRIEVAL AND EXTRACORPOREAL GASTRIC CONDUIT FORMATION, IN MINIMALLY INVASIVE ESOPHAGECTOMY

Abstract

Purpose: Purpose of the present study is to report our technique of the use of percutaneous endoscopic gastrostomy (PEG) site excision biopsy wound, for specimen retrieval and gastric conduit formation, in minimally invasive oesophagectomy for oesophageal cancer.Methods: It is a retrospective comparative study where we present data of our 100 resectable oesophageal cancer patients who underwent postneoadjuvant minimally invasive oesophagectomy from January 2012 to September 2015. All of the patients had an initial staging endoscopic ultrasound with PEG placement. The prestudy (conventional) approach, i.e., laparoscopic gastric conduit formation along with specimen pull up from the cervical/thoracic wound is compared to the present (Study) group.Results: The two groups were similar for basic demographic variables, tumour stage, morphology and nutritional status. The primary endpoints were an operative time in minutes and any additional procedure-speci c complications. The rate of procedure speci c complications (Abdominal excision wound complications or conduit failure) was low 11%. PEG site excision biopsy was positive in two cases; one adenocarcinoma and one squamous carcinoma, both were mid to lower oesophageal tumours not involving gastroesophageal junction.Conclusions: Bene ts of the approach are ease of gastric conduit formation along with an additional second layer with less operative time through the small wound, avoidance of tumour specimen removal all the way through mediastinum from the cervical incision, and excision of a potential site of oesophageal cancer metastasis, without any added morbidity.Key words: Extracorporeal gastric conduit, minimally invasive oesophagectomy, percutaneous endoscopic gastrostomy