Totally minimally invasive Ivor-Lewis esophagectomy with manual pursestring and per-thoracic port placement of anvil in patients with thoracic esophageal cancer / 中华胸心血管外科杂志

ABSTRACT

Objective Totally MIIE with per-oral placement of anvil has been reported elsewhere,but MIIE with manual pursestring and per-thoracic port placement of anvil has been seldomly reported.The feasibility of the latter technique was proved in this study.Methods Patients with mid-lower thoracic esophageal cancer were prospectively treated with totally MIIE at Shanghai Cancer Center of Fudan University from Feberay 28,2013 to August 31,2013.Laproscopic intracorporeal construction of the gastric conduit and needle catheter J-tube were performed in the first stage of MIIE.In the second stage a hand sewn pursestring was made with endostitch system and the anvil of EEA stapler was inserted via the tenth inter costal port prior to the intrathoracic anastamosis.Short-term clinicopathologic outcomes were collected.Results 39 cases were treated with totally MIIE,media age 61 years,ranged 48-69 years,10 females and 29 males.There was 1 conversion to open surgery.The median duration of operation was 245 minutes.The median intraoperative blood loss was 210 ml.All the patients were margin negative and staged from pT1N0M0 to pT3N2M0.The average lymph node yields were 16.5 per patient.The median postoperative hospital stay was 7 days.There was no mortality.Perioperative morbidity occurred in 4 patients (10％).2 patients were complicated with late stage gastric paralysis which began 2 or 3 days after oral feeding and both recovered in 1 month.1 patient was with minor anastamotic leakage which was endoscopically demonstrated on the 14th day postoperatively and the patient recovered in 1 month post leakage.1 patient was complicated with severe pneumonitus and ARDS; the ICU stay of that case was 19 days and the recovered patient was discharged 27 days postoperatively.Conclusion MIIE with regular EEA stapler and intrathoracic anastamosis is feasible in patients with thoracic esophageal cancer.Prospective randomized clinical trials could be conducted to compare the open procedure and totally MIIE with regular EEA stapler.