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Successful transition from open to minimally invasive approach in Ivor Lewis esophagectomy: a single-center experience in Japan

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Abstract

Purpose

This study evaluates surgical outcomes of Ivor Lewis esophagectomy (ILE) in our institution, with the transition from open ILE to hybrid or totally minimally invasive ILE (MI-ILE).

Methods

Selected patients who underwent ILE for esophageal cancer between 2013 and 2020 were included. We retrospectively investigated the patients’ background characteristics and the short-term surgical outcomes.

Results

In this period, among a total of 858 esophagectomies, selected seventy-one patients (8.3%) underwent ILE, consisted of 17 cases with completely open procedures, 27 with hybrid MI-ILE, and 27 with total MI-ILE. The major indications for ILE were adenocarcinoma of the distal esophagus or esophagogastric junction (33.8%) and patients with prior treatment of head and neck cancer (31.0%). Among these approaches, there were no significant differences in the characteristics including age, body mass index (BMI), tumor location, preoperative therapy, and clinical TNM stage, except for histology. Compared to the completely open and hybrid groups, incidences of both total and severe complications in the total MI-ILE group were significantly lower (total 70.6 vs. 66.6 vs. 37.0%, p=0.036; severe 35.3 vs. 44.4 vs. 11.1%, p=0.023), and also, those of pneumonia (41.2 vs. 29.6 vs. 7.4%, p=0.026) and postoperative stricture (11.8 vs. 18.5 vs. 0%, p=0.001) were significantly fewer in the total MI-ILE group.

Conclusions

We have been able to achieve the transition from completely open to total MI-ILE with better short-term outcomes. Total MI-ILE with linear-stapled anastomosis can be a good alternative to open procedures for the selected patients with reducing the incidence of postoperative pneumonia and anastomotic stricture.

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Acknowledgements

The authors would like to thank Enago (www.enago.jp) for the English language review.

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Authors and Affiliations

  1. Department of Esophageal Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Jun Kanamori, Masayuki Watanabe, Ryotaro Kozuki, Tasuku Toihata, Reiko Otake, Keita Takahashi, Akihiko Okamura, Yu Imamura & Shinji Mine

Authors
  1. Jun Kanamori
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  2. Masayuki Watanabe
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  3. Ryotaro Kozuki
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  4. Tasuku Toihata
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  5. Reiko Otake
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  6. Keita Takahashi
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  7. Akihiko Okamura
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  8. Yu Imamura
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  9. Shinji Mine
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Contributions

Study conception and design: all authors. Acquisition of data: all authors.

Analysis and interpretation of data: Kanamori, Watanabe, and Mine. Drafting of manuscript: Kanamori, Watanabe, and Mine. Critical revision of manuscript: all authors.

Corresponding author

Correspondence to Masayuki Watanabe.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

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The authors declare no competing interests.

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Kanamori, J., Watanabe, M., Kozuki, R. et al. Successful transition from open to minimally invasive approach in Ivor Lewis esophagectomy: a single-center experience in Japan. Langenbecks Arch Surg 406, 1407–1414 (2021). https://doi.org/10.1007/s00423-021-02150-8

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  • DOI: https://doi.org/10.1007/s00423-021-02150-8

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