Cardiothoracic Surgery |

A Prospective Study of Totally Minimally Invasive Ivor Lewis Esophagectomy With Regular Circular Stapler in Patients With Thoracic Esophageal Cancer FREE TO VIEW

Hecheng Li, MD; Longfei Ma, MD; Yiliang Zhang, MD; Yawei Zhang, MD; Jiaqing Xiang, MD; Haiquan Chen, PhD
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Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China

Chest. 2014;145(3_MeetingAbstracts):51A. doi:10.1378/chest.1832357
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SESSION TITLE: Thoracic Surgery Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Totally minimally invasive Ivor Lewis esophagectomy(MIIE) with per-oral placement of anvil has been reported elsewhere, but MIIE with manual pursestring and per-thoracic port placement of anvil has been seldomly reported. 27 cases with the later technique were conducted in this prospective study.

METHODS: Patients with mid-lower thoracic esophageal cancer were prospectively treated with totally MIIE at Shanghai Cancer Center of Fudan University from Feb. 28,2013 to Aug. 31,2013. Laproscopic intracorporeal construction of the gastric conduit and needle catheter J-tube were performed in the first stage of MIIE procedure. In the second stage a hand sewn pursestring was made with endo-stitch system and the anvil of EEA stapler was inserted via the tenth inter costal port prior to the intrathoracic anastamosis. Short-term clinicopathologic outcomes were collected.

RESULTS: 27 cases were treated with totally MIIE( mean age 59, range 48-68, 3 female:24male). There was one conversion to open surgery in this group of patients. The median duration of operation was 210 minutes(range 200-438 minutes). Median totally intraoperative blood loss was 240ml(range 100-450ml).There were no perioperative blood transfusion. All the patients were margin negative and pathalogically staged from T1N0M0 to T3N2M0. The lymph node yields were 16.8. All patients took oral feeding on the 6th postoperative day and the median postoperative hospital stay was 7days. There was no mortality. Minor morbidity occurred in 2 patients (9.5%) after discharge and they were complicated with late stage gastric paralysis which began 2 or 3 days after oral feeding and both recovered in 1 month. Major morbidity occurred in 2 patients (9.5%) after discharge and one patient was complicated with intestinal obstruction and the other one was with minor anastamotic leakage which were endoscopically demonstrated on the 14th day postoperatively and the patient recovered in 1 month.

CONCLUSIONS: MIIE with regular EEA stapler and intrathoracic anastamosis is feasible in patients with mid-lower thoracic esophageal cancer. Prospective randomized clinical trials could be conducted to compare the open procedure and totally MIIE with regular EEA stapler.

CLINICAL IMPLICATIONS: Totally minimally invasive Ivor-Lewis surgery could be safely conducted for mid-lower thoracic esophageal cancer.

DISCLOSURE: The following authors have nothing to disclose: Hecheng Li, Longfei Ma, Yiliang Zhang, Yawei Zhang, Jiaqing Xiang, Haiquan Chen

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