scholarly journals Side-to-side esophagogastric anastomosis for minimally invasive Ivor-Lewis esophagectomy: operative technique and short-term outcomes

2021 ◽  
Author(s):  
Manrica Fabbi ◽  
Stefano De Pascale ◽  
Filippo Ascari ◽  
Wanda Luisa Petz ◽  
Uberto Fumagalli Romario
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Anastomotic Stricture ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Open Approach ◽  
Short Term ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

AbstractTotally minimally invasive Ivor-Lewis esophagectomy (TMIIL) is associated to lower rate of post-operative complication, decreases length of hospital stay and improves quality of life compared to open approach. Nevertheless, adaptation of TMIIL still proceeds at slow pace, mainly due to the difficulty to perform the intra-thoracic anastomosis and heterogeneity of surgical techniques. We present our experience with TMIIL utilizing a stapled side-to-side anastomosis. We retrospectively evaluated 36 patients who underwent a planned TMIIL from January 2017 to September 2020. Esophagogastric anastomoses were performed using a 3-cm linear-stapled side-to-side technique. General features, operative techniques, pathology data and short-term outcomes were analyzed. The median operative time was 365 min (ranging from 240 to 480 min) with a median blood loss of 100 ml (50–1000 ml). The median overall length of stay was 13 (7–64) days and in-hospital mortality rate was 2.8%. Two patients (5.6%) had an anastomotic leak, without need for operative intervention and another patient developed an anastomotic stricture, resolved with a single endoscopic dilation. Chylothorax occurred in three patients; two of these required a surgical intervention. Pulmonary complications occurred in six patients (16.7%). Based on Comprehensive Complications Index (CCI), median values of complications were 27.9 (ranging from 20.9 to 100). The results of our study suggest that TMIIL with a 3-cm linear-stapled anastomosis seems to be safe and effective, with low rates of post-operative anastomotic leak and stricture.

scholarly journals Totally mechanical linear stapled anastomosis for minimally invasive Ivor Lewis esophagectomy: Operative technique and short‐term outcomes

2020 ◽  
Vol 11 (3) ◽  
pp. 769-776 ◽  
Author(s):  
Hui‐Jiang Gao ◽  
Ju‐Wei Mu ◽  
Wei‐Min Pan ◽  
Malcolm Brock ◽  
Mao‐Long Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Operative Technique ◽  
Stapled Anastomosis ◽  
Short Term ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Linear Stapled Anastomosis

scholarly journals Hand-sewn anastomosis for minimally invasive laparoscopic Ivor Lewis esophagectomy—how to do it: operative technique and short-term outcomes

2021 ◽  
Vol 0 ◽  
pp. 0-0
Author(s):  
Mauricio Ramirez ◽  
Matias Turchi ◽  
Federico Llanos ◽  
Adolfo Badaloni ◽  
Alejandro Nieponice
Keyword(s):  
Minimally Invasive ◽  
Operative Technique ◽  
Short Term ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

Short-Term Outcomes of Minimally Invasive Ivor-Lewis Esophagectomy for Esophageal Cancer

2014 ◽  
Vol 97 (5) ◽  
pp. 1721-1727 ◽  
Author(s):  
Ming-ran Xie ◽  
Chang-qing Liu ◽  
Ming-fa Guo ◽  
Xin-yu Mei ◽  
Xiao-hui Sun ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Short Term ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

Using the Hand-Sewn Purse-String Stapled Anastomotic Technique for Minimally Invasive Ivor Lewis Esophagectomy

2018 ◽  
Vol 67 (07) ◽  
pp. 578-584 ◽  
Author(s):  
Bicheng Zhan ◽  
Jian Chen ◽  
Shaoming Du ◽  
Yanzheng Xiong ◽  
Jian Liu
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Anastomotic Stricture ◽  
Circular Stapler ◽  
Fixation Time ◽  
Purse String ◽  
Ivor Lewis ◽  
Anastomotic Technique ◽  
Open Esophagectomy ◽  
Ivor Lewis Esophagectomy

Background Minimally invasive Ivor Lewis esophagectomy (MIILE) is increasingly being used in the treatment of middle or lower esophageal cancer. Hand-sewn purse-string stapled anastomosis is a classic approach in open esophagectomy. However, this procedure is technically difficult under thoracoscopy. The hardest part is delivering the anvil into the esophageal stump. Herein, we report an approach to performing this step under thoracoscopy. Methods A total of 257 consecutive patients who underwent MIILE between April 2013 and July 2017 were analyzed retrospectively. The operator hand sewed the purse string using silk thread under thoracoscopy, and the 25-mm circular stapler was passed through the anterior axillary line at the fourth intercostal space to finish the side-to-end gastroesophageal anastomosis. Patient demographics, intraoperative data, postoperative complications were evaluated. Results The mean operative time, thoracoscopy time, and anvil fixation time was 307.0 ± 34.3, 155.4 ± 21.5, and 7.1 ± 1.6 minute, respectively. The anastomotic leak and anastomotic stricture occurred in 6.6% (17 of 257) and 3.9% (10 of 257) of patients, respectively. There was no intraoperative death; one case was death of acute respiratory distress syndrome (ARDS) for conduit gastric leakage on the 21st postoperative day. Conclusion Using the hand-sewn purse-string stapled anastomotic technique for MIILE is feasible and relatively safe in patients with middle or lower esophageal cancer.

Minimally Invasive Ivor Lewis Esophagectomy after Induction Therapy Yields Similar Early Outcomes to Surgery Alone

2011 ◽  
Vol 6 (5) ◽  
pp. 331-336 ◽  
Author(s):  
Luis F. Tapias ◽  
Christopher R. Morse
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Neoadjuvant Therapy ◽  
Neoadjuvant Chemoradiotherapy ◽  
R0 Resection ◽  
Short Term ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Estimated Blood Loss ◽  
Short Term Mortality

Objective Although considered an integral part of treatment for regionally advanced esophageal cancer, there is conflicting literature regarding the effect of neoadjuvant chemoradiotherapy on esophagectomy. The objectives of this study are to examine the effect of neoadjuvant therapy in regard to perioperative parameters, morbidity, and short-term mortality in patients undergoing a minimally invasive Ivor Lewis esophagectomy (MIE). Methods This is a retrospective review of 39 patients undergoing MIE for esophageal cancer during 2007–2010. Results Of the 39 patients, 14 (36%) did not receive neoadjuvant therapy (NCR) and 25 (64%) did receive either chemoradiotherapy or chemotherapy (CR). On comparing NCR vs CR, there was no difference in operative time (361 vs 362 minutes; P = 0.94) or estimated blood loss (233 vs 190 mL; P = 0.06). All patients underwent an R0 resection, and there was no difference in the mean number of lymph nodes harvested (NCR 21.5 vs CR 21.6; P = 0.95). Both groups had mean intensive care unit stay of 1 day (P = 0.7), and there was no difference in length of stay (NCR 7.4 vs CR 8.2 days; P = 0.38). There were no deaths or anastomotic leaks in either group. The incidence of complications in the NCR group was 21% (3/14) while in the CR group was 48% (12/25). Complications were not associated with neoadjuvant therapy [CR vs NCR: odds ratio = 3.44 (0.72–16.38); P = 0.121], even after adjusting for comorbidities and age. Conclusions MIE can be performed safely following neoadjuvant therapy with similar perioperative results, morbidity, and short-term mortality when compared with MIE alone. Longer follow-up is required for oncologic validity.

scholarly journals The effect of age on short-term and mid-term outcomes after thoracoscopic Ivor Lewis esophagectomy: a propensity score-matched analysis

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Friederike Martin ◽  
Dino Kröll ◽  
Sebastian Knitter ◽  
Tobias Hofmann ◽  
Jonas Raakow ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Propensity Score ◽  
Elderly Patients ◽  
Disease Free Survival ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Disease Free

Abstract Background The number of elderly patients diagnosed with esophageal cancer rises. Current information about outcomes in elderly patients undergoing thoracoscopic Ivor Lewis esophagectomy is limited. The objective of this study was to evaluate the influence of age on short-and mid-term outcomes after thoracoscopic Ivor Lewis esophagectomy. Methods A retrospective review of 188 patients with esophageal cancer undergoing thoracoscopic Ivor Lewis esophagectomy between August 2014 and July 2019 was performed. Patients were divided into patients aged > 75 years (elderly group (EG), n = 37) and patients ≤ 75 years (younger group (YG), n = 151) and matched using propensity-score matching. Baseline characteristics, length of hospital stay, mortality and major postoperative complications (Clavien-Dindo ≥ grade III) were compared. Results After matching 74 patients remained (n = 37 in each group). Postoperatively, no significant differences in major and overall complications, intra-hospital and 30-day mortality, disease-free or overall survival up to 3 years after surgery were noted. The incidence of pulmonary complications (65% vs. 38%) and pneumonia (54% vs. 30%) was significantly higher and the median hospital length of stay (12 vs. 14 days) significantly longer in the EG versus YG. Conclusion Thoracoscopic Ivor Lewis esophagectomies resulted in acceptable postoperative major morbidity and mortality without compromising 3-years overall and disease-free survival in elderly compared to younger patients with esophageal cancer. However, the incidence of postoperative pulmonary complications was higher in patients aged over 75 years.

384 SHORT-TERM OUTCOMES OF INTRA-THORACIC ESOPHAGO-GASTRIC ANASTOMOSES UNDER MINIMALLY INVASIVE ESOPHAGECTOMY VIA A PRONE POSITION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Shinji Mine ◽  
Masayuki Watanabe ◽  
Atushi Kanamori ◽  
Yu Imamura ◽  
Akihiko Okamura ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Stricture ◽  
Minimally Invasive Esophagectomy ◽  
Anterior Wall ◽  
Gastric Conduit ◽  
Linear Stapler ◽  
Short Term ◽  
Invasive Esophagectomy ◽  
Operative Complications ◽  
Gastric Anastomosis

Abstract   Although minimally invasive esophagectomy (MIE) has been performed for esophageal cancer worldwide, intra-thoracic anastomosis under prone positions is still challenging. In this retrospective study, we reviewed our short-term results of this anastomotic technique in our institution. Methods From November 2016 to December 2019, we performed 319 esophagectomies. Of these patients, 28 patients (9%) underwent intra-thoracic esophago-gastric anastomosis under MIE. Procedures The left side of an esophageal stump which had been closed using a linear stapler was opened for anastomosis. Then, the anterior wall of a gastric conduit, around 5 cm below the tip, was opened for anastomosis. Linear staplers were inserted in both esophageal stump and gastric conduit and side-to-side anastomosis was performed. The opening for insertion was closed using a hand-sewn anastomosis in 2 layers. Results Five patients (18%) suffered anastomotic leakage with Clavien-Dindo 2 and 3a, and all of them recovered by conservative treatments. Two patients (2/19, 11%) showed anastomotic stricture which improved by several endoscopic dilatations. Six patients (6/19, 32%) showed the reflux esophagitis of Grade C. Conclusion Although we have not experienced severe or critical post-operative complications, the short-term results of intra-thoracic anastomosis under MIE were not sufficient. Additional progresses in techniques are required.

792 OUTCOMES AFTER TOTALLY MINIMALLY INVASIVE VERSUS HYBRID OR OPEN IVOR LEWIS ESOPHAGECTOMY: RESULTS FROM THE INTERNATIONAL ESODATA STUDY GROUP.

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Berend Van Der Wilk ◽  
Eliza R C Hagens ◽  
Ben M Eyck ◽  
Suzanne S Gisbertz ◽  
Richard Hillegersberg ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Hospital Length Of Stay ◽  
Mortality Data ◽  
Study Group ◽  
Ivor Lewis ◽  
Open Esophagectomy ◽  
Ivor Lewis Esophagectomy ◽  
The Impact

Abstract   To compare complications following totally minimally invasive (TMIE), laparoscopically assisted (hybrid) and open Ivor Lewis esophagectomy in patients with esophageal cancer. Three randomized trials have reported benefits for minimally invasive esophagectomy. Two studies compared TMIE versus open esophagectomy and another compared hybrid versus open Ivor Lewis esophagectomy. Only small retrospective studies compared TMIE with hybrid Ivor Lewis esophagectomy. Methods Data were used from the International Esodata Study Group assessing patients undergoing TMIE, hybrid or open Ivor Lewis esophagectomy. Primary outcome was pneumonia, secondary outcomes included incidence and severity of anastomotic leakage, (major) complications, length of stay, escalation of care and 90-day mortality. Data were analyzed using multivariate multilevel models. Results In total, 4733 patients were included in this study (TMIE:1472, hybrid:1364 and open:1897). Patients undergoing TMIE had lower incidence of pneumonia compared to hybrid (10.9% vs 16.3%, Odds Ratio (OR):0.56, 95%CI: 0.40–0.80) and open esophagectomy (10.9% vs 17.4%, OR:0.60, 95%CI: 0.42–0.84) and had shorter length of stay (median 10 days (IQR 8–16)) compared to hybrid (14 (11–19), p = 0.041) and open esophagectomy (11 (9–16), p = 0.027). Patients undergoing TMIE had higher rate of anastomotic leakage compared to hybrid (15.1% vs 10.7%, OR:1.47, 95%CI: 1.01–2.13) and open esophagectomy (7.3%, OR:1.73, 95%CI: 1.26–2.38). No differences were reported between hybrid and open esophagectomy. Conclusion Compared to hybrid and open Ivor Lewis esophagectomy, TMIE resulted in a lower pneumonia rate, a shorter hospital length of stay but a higher anastomotic leakage rate. The impact of these individual complications on survival and long-term quality of life should be further investigated.

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