[Standardised Minimally Invasive Ivor-Lewis Hybrid Oesophagectomy - Safe Anastomosis and Low Morbidity/Mortality].

Abstract

Background: Real world data of unselected series with standardised management are important for the comparison of different techniques of minimally invasive oesophagectomy.

Patients and methods: This is a retrospective study of a consecutive cohort of 193 minimally invasive hybrid oesophagectomies (laparoscopic/thoracotomy) including 9 conversions (4.6%) and 4 primary open oesophagectomies, in total with 195 gastric and 2 colonic interpositions (196 intrathoracic anastomoses and 1 cervical esophagogastrostomy). No patient had distant metastasis except 1 with hepatic lesions, who was resected, because of recurrent cancer bleeding during chemotherapy. 78% had adeno- and 20% squamous cell carcinomas. 65 of the tumours were cT3, 20 % cT2, 14% cT1. 77% of the patients underwent neoadjuvant chemotherapy with FLOT or radiochemotherapy with CROSS including 6 with definitive radiochemotherapy and salvage surgery.

Results: The R0-resection rate was 99% and a median of 34 lymph nodes was resected. The rate of anastomotic leakage was 1.5%, (n = 3), pneumonia 11%, chylothorax 1.5%, postoperative bleeding 0,5% and revisional surgery 2%. The 30- and 90- day mortality rates were 1.5% or 4.6%, respectively. One of 3 patients with anastomotic leakage had a fatal outcome despite endoscopic therapy.

Conclusion: The reported technique of hybrid minimally invasive oesophagectomy is safe, with a very low rate of anastomotic leakage. This benchmark is important for the comparison with the results of other types of minimally invasive Ivor-Lewis oesophagectomy.