Abstract
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.
Keywords
minimally invasive esophagectomy - esophageal cancer - esophagogastric anastomosis
- purse-string stapled anastomotic technique
