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Minimally Invasive Ivor Lewis Esophagectomy with Linear Stapled Anastomosis Associated with Low Leak and Stricture Rates

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Journal of Gastrointestinal Surgery Aims and scope

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Abstract

Background

Minimally invasive foregut surgery is increasingly performed for both benign and malignant diseases. We present a retrospective series of patients who underwent minimally invasive Ivor Lewis esophagectomy (MIE) with linear stapled anastomosis performed at two centers in the USA, with a focus on evaluating leak and stricture rates.

Methods

Patients treated from 2007 to 2018 were included, and data on demographics, oncologic treatment, pathology, and outcomes were analyzed. The surgical technique utilized laparoscopic and thoracoscopic access, with an intrathoracic esophagogastric anastomosis using a 6-cm linear stapled side-to-side technique.

Results

A total of 124 patients were included and 114 resections (91.9%) were completed in a minimally invasive fashion with a 6-cm linear stapled side-to-side anastomosis. Patients were predominantly male (90.7%) with a median age of 66.0 years and body mass index of 28.8 kg/m2. Of 121 patients with malignancy, negative margins were obtained in 94.3% and median lymph node yield was 15 (IQR 12–22). In the intention to treat analysis, median operative time was 463 min (IQR 403–515), blood loss was 150 mL (IQR 100–200), and length of stay was 8 days (IQR 7–11). Postoperative complications were experienced by 64 patients (51.6%) including respiratory failure in 14 (11.3%) and pneumonia in 12 (9.7%). In patients who successfully underwent a 6-cm stapled side-to-side anastomosis, anastomotic leaks occurred in 6 patients (5.1%) without need for operative intervention, and anastomotic strictures occurred in 6 patients (5.1%) requiring endoscopic management.

Conclusions

Ivor Lewis MIE with a 6-cm linear stapled anastomosis can be completed with a high technical success rate, and low rates of anastomotic leak and stricture.

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Funding

This work was supported by Roswell Park Cancer Institute and National Cancer Institute [grant number P30CA016056].

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY, 14203, USA

    Moshim Kukar, June S. Peng & Steven N. Hochwald

  2. Department of Surgery, Mount Sinai Medical Center, Miami Beach, FL, USA

    Kfir Ben-David

  3. Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

    Kristopher Attwood

  4. Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA

    Ryan M. Thomas

  5. North Florida/South Georgia Veterans Health System, Gainesville, FL, USA

    Ryan M. Thomas

  6. Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

    Mark Hennon & Chukwumere Nwogu

Authors
  1. Moshim Kukar
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  2. Kfir Ben-David
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  3. June S. Peng
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  4. Kristopher Attwood
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  5. Ryan M. Thomas
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  6. Mark Hennon
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  7. Chukwumere Nwogu
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  8. Steven N. Hochwald
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Contributions

Conception and design: Kukar, Ben-David, Peng, Attwood, Thomas, Hennon, Nwogu, Hochwald.

Data acquisition and interpretation: Kukar, Ben-David, Peng, Attwood, Thomas, Hochwald.

Manuscript draft and critical revisions: Kukar, Ben-David, Peng, Attwood, Thomas, Hennon, Nwogu, Hochwald.

Final approval: Kukar, Ben-David, Peng, Attwood, Thomas, Hennon, Nwogu, Hochwald.

Corresponding author

Correspondence to Steven N. Hochwald.

Ethics declarations

This retrospective study was approved by the Institutional Review Boards of the participating institutions including Shands Hospital at the University of Florida and Roswell Park Comprehensive Cancer Center.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Kukar, M., Ben-David, K., Peng, J.S. et al. Minimally Invasive Ivor Lewis Esophagectomy with Linear Stapled Anastomosis Associated with Low Leak and Stricture Rates. J Gastrointest Surg 24, 1729–1735 (2020). https://doi.org/10.1007/s11605-019-04320-y

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  • DOI: https://doi.org/10.1007/s11605-019-04320-y

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