Journal of Gastrointestinal Surgery

, Volume 17, Issue 11, pp 1972–1979 | Cite as

Hybrid Trans-thoracic Esophagectomy with Side-to-Side Stapled Intra-thoracic Esophagogastric Anastomosis for Esophageal Cancer

  • Marco E. Allaix
  • Fernando A. Herbella
  • Marco G. Patti
How I do it


Esophagectomy is the primary treatment modality for non-metastatic esophageal cancer. A trans-thoracic approach is used in most centers in the United States. Anastomotic complications, such as leakage and stricture, are associated with worse short-term and long-term outcomes. Recent data suggest that a side-to-side mechanical intra-thoracic esophagogastric anastomosis is associated with a reduced rate of anastomotic leaks and strictures. This article describes the technique of trans-thoracic hybrid esophagectomy with side-to-side intra-thoracic esophagogastric anastomosis for esophageal cancer.


Esophageal cancer Laparoscopic esophagectomy Thoracotomy Esophagogastric anastomosis Anastomotic leak 


Conflict of Interest

The authors have no conflicts of interest to declare.


  1. 1.
    Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med. 2003;349:2241-2252.PubMedCrossRefGoogle Scholar
  2. 2.
    Boshier PR, Anderson O, Hanna GB. Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer: a meta-analysis. Ann Surg 2011;254:894-906.PubMedCrossRefGoogle Scholar
  3. 3.
    Luketich JD, Pennathur A, Awais O, Levy RM, Keeley S, Shende M, Christie NA, Weksler B, Landreneau RJ, Abbas G, Schuchert MJ, Nason KS. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg. 2012;256:95-103.PubMedCrossRefGoogle Scholar
  4. 4.
    Nagpal K, Ahmed K, Vats A, Yakoub D, James D, Ashrafian H, Darzi A, Moorthy K, Athanasiou T. Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc. 2010;24:1621-1629.PubMedCrossRefGoogle Scholar
  5. 5.
    Biere SSAY, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, Gisbertz SS, Klinkenbijl JHG, Hollmann MW, de Lange ESM, Bonjer HJ, van der Peet DL, Cuesta MA. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicenter, open-label, randomized controlled trial. Lancet 2012;379:1887-1892.PubMedCrossRefGoogle Scholar
  6. 6.
    Collard JM, Romagnoli R, Goncette L, Otte JB, Kestens PJ. Terminalized semimechanical side-to-side suture technique for cervical esophagogastrostomy. Ann Thorac Surg 1998;65:814-817.PubMedCrossRefGoogle Scholar
  7. 7.
    Müller JM, Erasmi H, Stelzner M, Zieren U, Pichlmaier H. Surgical therapy of oesophageal carcinoma. Br J Surg. 1990;77:845-857.PubMedCrossRefGoogle Scholar
  8. 8.
    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;49:163-167.PubMedCrossRefGoogle Scholar
  9. 9.
    Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg. 1995;169:634-640.PubMedCrossRefGoogle Scholar
  10. 10.
    Martin LW, Swisher SG, Hofstetter W, Correa AM, Mehran RJ, Rice DC, Vaporciyan AA, Walsh GL, Roth JA. Intrathoracic leaks following esophagectomy are no longer associated with increased mortality. Ann Surg. 2005;242(3):392-399.PubMedGoogle Scholar
  11. 11.
    Cense HA, Lagarde SM, de Jong K, Omloo JM, Busch OR, Henny ChP, van Lanschot JJ. Association of no epidural anesthesia with postoperative morbidity and mortality after transthoracic esophageal cancer resection. J Am Coll Surg 2006;202:395-400.PubMedCrossRefGoogle Scholar
  12. 12.
    Gasper WJ, Glidden DV, Jin C, Way LW, Patti MG. Has recognition of the relationship between mortality rates and hospital volume for major cancer surgery in California made a difference?: a follow-up analysis of another decade. Ann Surg. 2009;250:472-483.PubMedGoogle Scholar
  13. 13.
    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;99:1547-1553.PubMedCrossRefGoogle Scholar
  14. 14.
    Vigneswaran WT, Trastek VF, Pairolero PC, Deschamps C, Daly RC, Allen MS. Transhiatal esophagectomy for carcinoma of the esophagus. Ann Thorac Surg. 1993;56:838-844.PubMedCrossRefGoogle Scholar
  15. 15.
    Orringer MB, Marshall B, Iannettoni MD. Transhiatal esophagectomy: clinical experience and refiniments. Ann Surg 1999;230:392-403.PubMedCrossRefGoogle Scholar
  16. 16.
    Chang AC, Orringer MB. Management of the cervical esophagogastric anastomotic strict. Semin Thorac Cardiovasc Surg. 2007;19:66-71.PubMedCrossRefGoogle Scholar
  17. 17.
    Kim RH, Takabe K. Methods of esophagogastric anastomoses following esophagectomy for cancer: a systematic review. J Surg Oncol 2010;101:527-533.PubMedCrossRefGoogle Scholar
  18. 18.
    Orringer MB, Marshall B, Iannettoni MD. Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg 2000;119:277-288.PubMedCrossRefGoogle Scholar
  19. 19.
    Orringer MB, Marshall B, Chang AC, Lee J, Pickens A, Lau CL. Two thousand transhiatal esophagectomies: changing trends, lessons learned. Ann Surg. 2007;246:363-372.PubMedCrossRefGoogle Scholar
  20. 20.
    Cooke DT, Lin GC, Lau CL, Zhang L, Si MS, Lee J, Chang AC, Pickens A, Orringer MB. Analysis of cervical esophagogastric anastomotic leaks after transhiatal esophagectomy: risk factors, presentation, and detection. Ann Thorac Surg. 2009;88:177-184.PubMedCrossRefGoogle Scholar
  21. 21.
    Ercan S, Rice TW, Murthy SC, Rybicki LA, Blackstone EH. Does esophagogastric anastomotic technique influence the outcome of patients with esophageal cancer? J Thorac Cardiovasc Surg. 2005;129:623-631.PubMedCrossRefGoogle Scholar
  22. 22.
    Blackmon SH, Correa AM, Wynn B, Hofstetter WL, Martin LW, Mehran RJ, Rice DC, Swisher SG, Walsh GL, Roth JA, Vaporciyan AA. Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis. Ann Thorac Surg. 2007;83:1805-1813.PubMedCrossRefGoogle Scholar
  23. 23.
    Raz DJ, Tedesco P, Herbella FA, Nipomnick I, Way LW, Patti MG. Side-to-side stapled intra-thoracic esophagogastric anastomosis reduces the incidence of leaks and stenosis. Dis Esophagus. 2008;21:69-72.PubMedGoogle Scholar
  24. 24.
    Ben-David K, Sarosi GA, Cendan JC, Hochwald SN. Technique of minimally invasive Ivor Lewis esophagogastrectomy with intrathoracic stapled side-to-side anastomosis. J Gastrointest Surg. 2010;14:1613-1618.PubMedCrossRefGoogle Scholar
  25. 25.
    Gorenstein LA, Bessler M, Sonett JR. Intrathoracic linear stapled esophagogastric anastomosis: an alternative to the end to end anastomosis. Ann Thorac Surg. 2011;91:314-316.PubMedCrossRefGoogle Scholar
  26. 26.
    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;17:397-402.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Marco E. Allaix
    • 1
  • Fernando A. Herbella
    • 1
  • Marco G. Patti
    • 1
  1. 1.Department of Surgery and Center for Esophageal DiseasesUniversity of Chicago Pritzker School of MedicineChicagoUSA

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