[en] Objective: Totally minimally invasive Ivor-Lewis Esophagectomy (TMIE) is increasingly performed around the world with the goal of reducing morbidity. The intrathoracic anastomosis is a key element in the procedure. This retrospective study reports the perioperative outcomes after TMIE with intrathoracic hand-sewn anastomosis in our center.
Methods: All consecutive patients who underwent Ivor-Lewis TMIE for cancer from 2017 to 2022 were retrospectively analyzed from a prospective maintained database. Data included demographic variables, primary tumor characteristics and management, operative data, tumor pathology and outcomes.
Results: Sixty-one patients were included in this study with a mean age of 65 years (38-82). Histology of the tumor was adenocarcinoma in 55 cases (90 %), squamous cell carcinoma in 5 cases (8%) and primary esophageal melanoma in 1 case. Tumor was located in the lower third of the esophagus in 38 patients (62%), the esogastric junction in 22 cases (36%) and in the middle third of the esophagus in 1 case. 45 patients (74%) received neoadjuvant treatment. The median operative time was 301 minutes (205-540). R0 resection was achieved in 59 patients (97%) and proportion of patients with more than 15 lymph nodes removed was 92% (n=56). The overall major morbidity (Clavien Dindo 3b-V) was 21 % (n=13). No complication was observed in 47.5 % of the patients. Anastomotic leaks occurred in 16 % of the cases (n=10) and were classified type I in 6 cases and type II in 4 cases. Pulmonary complication was seen in 19.7 %. No chyle leak was observed. 5 patients required reoperation including abdominal bleeding in 2 cases and acute hiatal hernia in 3 cases. Median length of stay was 13 days (9-105). Thirty-day and 90-day mortality rates were respectively 1.6 % (n=1) and 3.3 % (n=2).
Conclusion: TMIE with intrathoracic hand-sewn anastomosis is feasible and reproducible with acceptable morbidity and mortality rates.
Disciplines :
Surgery
Author, co-author :
KOHNEN, Laurent ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie abdo, sénologique, endocrine et de transplantation
Neuberg, Maud ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie abdo, sénologique, endocrine et de transplantation
