Reverse-puncture anastomosis in minimally invasive Ivor-Lewis esophagectomy for lower esophageal carcinoma: A single-center retrospective study
- VernacularTitle:反穿刺法微创Ivor-Lewis食管癌根治术在食管下段癌中应用的单中心回顾性分析
- Author:
Xiang FEI
1
;
Lixin YANG
1
;
Xin LI
1
;
Ji ZHU
1
;
Hai JIN
1
;
Hezhong CHEN
1
;
Chaojing LU
1
Author Information
1. Department of Thoracic Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, P. R. China
- Publication Type:Journal Article
- Keywords:
Esophageal cancer;
minimally invasive esophagectomy;
Ivor-Lewis;
reverse-puncture anastomosis;
prognosis
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2024;31(03):364-370
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical efficacy of minimally invasive Ivor-Lewis esophagectomy (MIILE) with reverse-puncture anastomosis. Methods Clinical data of the patients with lower esophageal carcinoma who underwent MIILE with reverse-puncture anastomosis in our department from May 2015 to December 2020 were collected. Modified MIILE consisted of several key steps: (1) pylorus fully dissociated; (2) making gastric tube under laparoscope; (3) dissection of esophagus and thoracic lymph nodes under artificial pneumothorax with single-lumen endotracheal tube intubation in semi-prone position; (4) left lung ventilation with bronchial blocker; (5) intrathoracic anastomosis with reverse-puncture anastomosis technique. Results Finally 248 patients were collected, including 206 males and 42 females, with a mean age of 63.3±7.4 years. All 248 patients underwent MIILE with reverse-puncture anastomosis successfully. The mean operation time was 176±35 min and estimated blood loss was 110±70 mL. The mean number of lymph nodes harvested from each patient was 24±8. The rate of lymph node metastasis was 43.1% (107/248). The pulmonary complication rate was 13.7% (34/248), including 6 patients of acute respiratory distress syndrome. Among the 6 patients, 2 patients needed endotracheal intubation-assisted respiration. Postoperative hemorrhage was observed in 5 patients and 2 of them needed hemostasis under thoracoscopy. Thoracoscopic thoracic duct ligation was performed in 1 patient due to the type Ⅲ chylothorax. TypeⅡ anastomotic leakage was found in 3 patients and 1 of them died of acute respiratory distress syndrome. One patient of delayed broncho-gastric fistula was cured after secondary operation. Ten patients with type Ⅰ recurrent laryngeal nerve injury were cured after conservative treatment. All patients were followe up for at least 16 months. The median follow-up time was 44 months. The 3-year survival rate was 71.8%, and the 5-year survival rate was 57.8%. Conclusion The optimized MIILE with reverse-puncture anastomosis for the treatment of lower esophageal cancer is safe and feasible, and the long-term survival is satisfactory.
