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

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.

Download Full-text

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

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2014.01.054 ◽

2014 ◽

Vol 97 (5) ◽

pp. 1721-1727 ◽

Cited By ~ 25

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

Download Full-text

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

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182364e5d ◽

2011 ◽

Vol 6 (5) ◽

pp. 331-336 ◽

Cited By ~ 3

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.

Download Full-text

Comparison of short-term outcomes between minimally invasive McKeown and Ivor Lewis esophagectomy for esophageal or junctional cancer: a systematic review and meta-analysis

OncoTargets and Therapy ◽

10.2147/ott.s169488 ◽

2018 ◽

Vol Volume 11 ◽

pp. 6057-6069 ◽

Cited By ~ 6

Author(s):

Jianqing Deng ◽

Qingqing Su ◽

Zhipeng Ren ◽

Jiaxin Wen ◽

Zhiqiang Xue ◽

...

Keyword(s):

Systematic Review ◽

Minimally Invasive ◽

Meta Analysis ◽

Short Term ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy

Download Full-text

Indocyanine green perfusion assessment of the gastric conduit in minimally invasive Ivor Lewis esophagectomy

Surgical Endoscopy ◽

10.1007/s00464-021-08346-9 ◽

2021 ◽

Author(s):

Keouna Pather ◽

Adeline M. Deladisma ◽

Christina Guerrier ◽

Isaac R. Kriley ◽

Ziad T. Awad

Keyword(s):

Minimally Invasive ◽

Indocyanine Green ◽

Gastric Conduit ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy ◽

Perfusion Assessment

Download Full-text

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

Diseases of the Esophagus ◽

10.1093/dote/doab052.792 ◽

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.

Download Full-text

Modified Intrathoracic Esophagogastrostomy with Minimally Invasive Robot-Assisted Ivor-Lewis Esophagectomy for Cancer

Digestive Surgery ◽

10.1159/000495361 ◽

2018 ◽

Vol 36 (3) ◽

pp. 218-225 ◽

Cited By ~ 2

Author(s):

Wen-Ping Wang ◽

Long-Qi Chen ◽

Han-Lu Zhang ◽

Yu-Shang Yang ◽

Song-Lin He ◽

...

Keyword(s):

Minimally Invasive ◽

Circular Stapler ◽

Purse String Suture ◽

Robot Assisted ◽

Purse String ◽

Ivor Lewis ◽

Intrathoracic Anastomosis ◽

Ivor Lewis Esophagectomy ◽

Estimated Blood Loss ◽

Esophagectomy For Cancer

Background: Intrathoracic esophagogastrostomy plays an important role in minimally invasive Ivor-Lewis esophagectomy for cancer. Intrathoracic anastomosis with robot-assisted Ivor-Lewis esophagectomy (RAILE) includes hand-sewn and circular stapler methods, which remain technically challenging. In this study, we modified the techniques for intrathoracic anastomosis at RAILE, in order to simplify the complex procedures. Methods: “Side-insertion” technique was used for anvil placement and purse string suture for intrathoracic anastomosis at RAILE. Medical records for consecutive patients who had undergone robot-assisted minimally invasive Ivor-Lewis esophagectomy for cancer between January 2015 and June 2018 were analyzed. Results: A total of consecutive 31 patients were enrolled. There was no conversion to open thoracotomy in this cohort. Mean operation duration in the robotic group was 387.4 ± 68.2 min. Median estimated blood loss was 110 mL (range 50–400 mL). Two patients (6.5%) had postoperative anastomotic leak. No postoperative reoperation was needed and there were no mortality. Six patients (19.4%) had anastomotic stricture and 2 patients of them needed endoscopic dilation. Conclusion: RAILE is safe and feasible. Our modified procedure highlighting the “side-insertion” method may simplify the process of intrathoracic anvil placement and purse string suture for anastomosis at RAILE.

Download Full-text