Minimally invasive Ivor-Lewis esophagectomy with linear stapled side-to-side anastomosis

Abstract

Background: An esophagectomy is still associated with a high complication rate, despite advancements in minimally invasive surgery, enhanced recovery after surgery (ERAS) and centralization. Particularly anastomotic complications negatively impact quality of life and long-term survival. These complications are associated with patient factors but also with technical aspects. Methods: We describe the technique for a linear side-to-side stapled intrathoracic anastomosis in patients that underwent a totally minimally invasive Ivor-Lewis esophagectomy (MIE-IL) at our institution between January 2016 and November 2020 and retrospectively assessed the outcomes. Results: A total of 246 patients underwent a MIE-IL with this anastomotic technique. Mean age was 65 years and anastomotic leakage (AL) rate was 8.9%. In half (n=11) of these patients (4.5%), these were minor leaks that could be managed conservatively [Type I leaks according to Esophagectomy Complications Consensus Group (ECCG) definition]. ECCG Type II leaks occurred in eight patients (3.3%) and were routinely managed with esophageal stenting. Three patients (1.2%) required a reoperation (ECCG Type III). Anastomotic stricture rate was 2.2% at 90 days postoperatively. Median length of hospital stay (LOHS) was 8 days. Hospital readmission rate was 10.2%. Mean duration of surgery was 249 (±36) minutes and surgical conversion rate was 0.8% (n=2). In-hospital mortality rate was 1.6% (n=4). One of these patients died due to SARS-CoV-2. Due to continuous improvements to the entire integrated care pathway, LOHS and overall postoperative complication rate significantly decreased over the years (median LOHS of 6 days and postoperative complication rate of 38.6% in 2020). Conclusions: The linear side-to-side stapled intrathoracic anastomotic technique is associated with a low rate of anastomotic complications and low mortality rate. © 2022 Journal of Innovation Management. All rights reserved.