Technique of open and minimally-invasive intrathoracic reconstruction following esophagectomy - an expert consensus based on a modified Delphi process

Background In recent years, minimally invasive Ivor Lewis (IL) esophagectomy with high intrathoracic anastomosis has emerged as surgical standard of care for esophageal cancer in expert centers. Alongside this process, many divergent technical aspects of this procedure have been devised in different centers. This study aims at achieving international consensus on the surgical steps of Ivor Lewis reconstruction using Delphi methodology.

Methods The expert panel consisted of specialized esophageal surgeons from 8 European countries. During a two-round Delphi process, a detailed analysis and consensus on key steps of intrathoracic gastric tube reconstruction (IL esophagectomy) was performed.

Results Response rates in Delphi rounds 1 and 2 were 100% (22 of 22 experts) and 83.3% (20 of 24 experts), respectively. Three essential technical areas of intrathoracic gastric tube reconstruction were identified: First, optimizing vascularization of the gastric conduit, second, gastric mobilization, tube formation and pull-up, and third, anastomotic technique. In addition, three main techniques for minimally invasive intrathoracic anastomosis are currently practiced:

1. end-to-side circular stapled,

2. end-to-side double stapling, and

3. side-to-side linear stapled technique.

The step-by-step procedural analysis unveiled common approaches but also different expert practice.

Conclusion This precise technical description may serve as a clinical guideline for intrathoracic reconstruction after esophagectomy. In addition, the results may harmonize the technical evolution of this complex surgical procedure and thereby facilitate surgical training.

Publication History

Article published online:
08 September 2020