Download PDF
Thorac Cardiovasc Surg 2019; 67(07): 578-584
DOI: 10.1055/s-0038-1660848
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Using the Hand-Sewn Purse-String Stapled Anastomotic Technique for Minimally Invasive Ivor Lewis Esophagectomy

Bicheng Zhan
1   Department of Cardiothoracic Surgery, Anqing Affiliated Hospital of Anhui Medical University, Anqing, Anhui, People's Republic of China
,
Jian Chen
1   Department of Cardiothoracic Surgery, Anqing Affiliated Hospital of Anhui Medical University, Anqing, Anhui, People's Republic of China
,
Shaoming Du
1   Department of Cardiothoracic Surgery, Anqing Affiliated Hospital of Anhui Medical University, Anqing, Anhui, People's Republic of China
,
Yanzheng Xiong
1   Department of Cardiothoracic Surgery, Anqing Affiliated Hospital of Anhui Medical University, Anqing, Anhui, People's Republic of China
,
Jian Liu
1   Department of Cardiothoracic Surgery, Anqing Affiliated Hospital of Anhui Medical University, Anqing, Anhui, People's Republic of China
› Author Affiliations
Further Information

Publication History

07 February 2018

10 May 2018

Publication Date:
28 June 2018 (online)

    Permissions and Reprints All articles of this category

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
 

  • References

  • 1 Chen W, Zheng R, Baade PD. , et al. Cancer statistics in China, 2015. CA Cancer J Clin 2016; 66 (02) 115-132
    CrossrefPubMedGoogle Scholar
  • 2 Cuschieri A, Shimi S, Banting S. Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb 1992; 37 (01) 7-11
    PubMedGoogle Scholar
  • 3 Luketich JD, Pennathur A, Franchetti Y. , et al. Minimally invasive esophagectomy: results of a prospective phase II multicenter trial-the eastern cooperative oncology group (E2202) study. Ann Surg 2015; 261 (04) 702-707
    CrossrefPubMedGoogle Scholar
  • 4 Maas KW, Biere SS, Scheepers JJ. , et al. Minimally invasive intrathoracic anastomosis after Ivor Lewis esophagectomy for cancer: a review of transoral or transthoracic use of staplers. Surg Endosc 2012; 26 (07) 1795-1802
    CrossrefPubMedGoogle Scholar
  • 5 Luketich JD, Pennathur A, Awais O. , et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg 2012; 256 (01) 95-103
    CrossrefPubMedGoogle Scholar
  • 6 Blackmon SH, Correa AM, Wynn B. , et al. Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis. Ann Thorac Surg 2007; 83 (05) 1805-1813 , discussion 1813
    CrossrefPubMedGoogle Scholar
  • 7 Okabe H, Tanaka E, Tsunoda S, Obama K, Sakai Y. Intrathoracic esophagogastric anastomosis using a linear stapler following minimally invasive esophagectomy in the prone position. J Gastrointest Surg 2013; 17 (02) 397-402
    CrossrefPubMedGoogle Scholar
  • 8 Sihag S, Wright CD, Wain JC. , et al. Comparison of perioperative outcomes following open versus minimally invasive Ivor Lewis oesophagectomy at a single, high-volume centre. Eur J Cardiothorac Surg 2012; 42 (03) 430-437
    CrossrefPubMedGoogle Scholar
  • 9 Zhang RQ, Xia WL, Kang NN, Ge W, Chen AG, Zhu KC. Pursestring stapled anastomotic technique for minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg 2012; 94 (06) 2133-2135
    CrossrefPubMedGoogle Scholar
  • 10 Wu W, Zhu Q, Chen L, Liu J. Technical and early outcomes of Ivor Lewis minimally invasive oesophagectomy for gastric tube construction in the thoracic cavity. Interact Cardiovasc Thorac Surg 2014; 18 (01) 86-91
    CrossrefPubMedGoogle Scholar
  • 11 Xie MR, Liu CQ, Guo MF, Mei XY, Sun XH, Xu MQ. Short-term outcomes of minimally invasive Ivor-Lewis esophagectomy for esophageal cancer. Ann Thorac Surg 2014; 97 (05) 1721-1727
    CrossrefPubMedGoogle Scholar
  • 12 Xiao P, Zhuang X, Shen Y. , et al. Reverse-puncture anastomotic technique for minimally invasive Ivor-Lewis esophagectomy. Ann Thorac Surg 2015; 100 (06) 2372-2375
    CrossrefPubMedGoogle Scholar
  • 13 Zhai C, Liu Y, Li W. , et al. A comparison of short-term outcomes between Ivor-Lewis and McKeown minimally invasive esophagectomy. J Thorac Dis 2015; 7 (12) 2352-2358
    PubMedGoogle Scholar
  • 14 Jeon HW, Park JK, Song KY, Sung SW. High intrathoracic anastomosis with thoracoscopy is safe and feasible for treatment of esophageal squamous cell carcinoma. PLoS One 2016; 11 (03) e0152151
    CrossrefPubMedGoogle Scholar
  • 15 Pan S, Shen G, Wu M. Usage of “Reversal Penetrating Technique” with ancillary trocar in minimally invasive Ivor Lewis esophagectomy. J Laparoendosc Adv Surg Tech A 2017; 27 (01) 67-70
    CrossrefPubMedGoogle Scholar
  • 16 Zhang H, Chen L, Geng Y, Zheng Y, Wang Y. Modified anastomotic technique for thoracolaparoscopic Ivor-Lewis esophagectomy: early outcomes and technical details. Dis Esophagus 2017; 30 (05) 1-5
    CrossrefPubMedGoogle Scholar
  • 17 Rice TW, Kelsen D, Blackstone EH. , et al. Esophagus and esophagogastric junction. In: Amin MB, Edge S, Greene F. , et al, eds. AJCC Cancer Staging Manual. 8th ed. New York: Springer; 2017: 185-202
    Google Scholar
  • 18 Briez N, Piessen G, Torres F, Lebuffe G, Triboulet JP, Mariette C. Effects of hybrid minimally invasive oesophagectomy on major postoperative pulmonary complications. Br J Surg 2012; 99 (11) 1547-1553
    CrossrefPubMedGoogle Scholar
  • 19 Yin G, Xu Q, Chen S. , et al. Fluoroscopically guided three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage. Korean J Radiol 2012; 13 (02) 182-188
    CrossrefPubMedGoogle Scholar
  • 20 Campos GM, Jablons D, Brown LM, Ramirez RM, Rabl C, Theodore P. A safe and reproducible anastomotic technique for minimally invasive Ivor Lewis oesophagectomy: the circular-stapled anastomosis with the trans-oral anvil. Eur J Cardiothorac Surg 2010; 37 (06) 1421-1426
    CrossrefPubMedGoogle Scholar
  • 21 Bakhos CT, Fabian T, Oyasiji TO. , et al. Impact of the surgical technique on pulmonary morbidity after esophagectomy. Ann Thorac Surg 2012; 93 (01) 221-226 , discussion 226–227
    CrossrefPubMedGoogle Scholar
  • 22 Atkins BZ, Fortes DL, Watkins KT. Analysis of respiratory complications after minimally invasive esophagectomy: preliminary observation of persistent aspiration risk. Dysphagia 2007; 22 (01) 49-54
    CrossrefPubMedGoogle Scholar
  • 23 Zingg U, Smithers BM, Gotley DC. , et al. Factors associated with postoperative pulmonary morbidity after esophagectomy for cancer. Ann Surg Oncol 2011; 18 (05) 1460-1468
    CrossrefPubMedGoogle Scholar
  • 24 Nakamura M, Iwahashi M, Nakamori M. , et al. An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer. Langenbecks Arch Surg 2008; 393 (02) 127-133
    CrossrefPubMedGoogle Scholar
  • 25 Thakkar CM, Kumar AV, Soni HN, Shah AJ, Patel KS, Haribhakti SP. Thoracoscopic part of minimal invasive oesophagectomy in semiprone position: our initial experience. Surg Laparosc Endosc Percutan Tech 2014; 24 (04) 337-341
    PubMedGoogle Scholar
  • 26 Andreou A, Biebl M, Dadras M. , et al. Anastomotic leak predicts diminished long-term survival after resection for gastric and esophageal cancer. Surgery 2016; 160 (01) 191-203
    CrossrefPubMedGoogle Scholar
  • 27 Patil PK, Patel SG, Mistry RC, Deshpande RK, Desai PB. Cancer of the esophagus: esophagogastric anastomotic leak--a retrospective study of predisposing factors. J Surg Oncol 1992; 49 (03) 163-167
    CrossrefPubMedGoogle Scholar
  • 28 Huang HT, Wang F, Shen L, Xia CQ, Lu CX, Zhong CJ. Comparison of thoracolaparoscopic esophagectomy with cervical anastomosis with McKeown esophagectomy for middle esophageal cancer. World J Surg Oncol 2015; 13: 310
    CrossrefPubMedGoogle Scholar
  • 29 Zhang J, Wang R, Liu S. , et al. Refinement of minimally invasive esophagectomy techniques after 15 years of experience. J Gastrointest Surg 2012; 16 (09) 1768-1774
    CrossrefPubMedGoogle Scholar
  • 30 van Halsema EE, Noordzij IC, van Berge Henegouwen MI, Fockens P, Bergman JJ, van Hooft JE. Endoscopic dilation of benign esophageal anastomotic strictures over 16 mm has a longer lasting effect. Surg Endosc 2017; 31 (04) 1871-1881
    CrossrefPubMedGoogle Scholar
  • 31 Ahmed Z, Elliott JA, King S, Donohoe CL, Ravi N, Reynolds JV. Risk factors for anastomotic stricture post-esophagectomy with a standardized sutured anastomosis. World J Surg 2017; 41 (02) 487-497
    CrossrefPubMedGoogle Scholar
  • 32 Harustiak T, Pazdro A, Snajdauf M, Stolz A, Lischke R. Anastomotic leak and stricture after hand-sewn versus linear-stapled intrathoracic oesophagogastric anastomosis: single-centre analysis of 415 oesophagectomies. Eur J Cardiothorac Surg 2016; 49 (06) 1650-1659
    CrossrefPubMedGoogle Scholar
  • 33 Pennathur A, Awais O, Luketich JD. Technique of minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg 2010; 89 (06) S2159-S2162
    CrossrefPubMedGoogle Scholar
  • 34 Dhamija A, Dhamija A, Hancock J. , et al. Minimally invasive oesophagectomy more expensive than open despite shorter length of stay. Eur J Cardiothorac Surg 2014; 45 (05) 904-909
    CrossrefPubMedGoogle Scholar