Reverse-puncture anastomosis in minimally invasive Ivor-Lewis esophagectomy for lower esophageal carcinoma: A single-center retrospective study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FEI Xiang , YANG Lixin , LI Xin , ZHU Ji , JIN Hai , CHEN Hezhong ,  LU Chaojing

1. Department of Thoracic Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, P. R. China;

Corresponding author：

LU Chaojing, Email: luchaojing@126.com

Keywords：

Esophageal cancer; minimally invasive esophagectomy; Ivor-Lewis; reverse-puncture anastomosis; prognosis

DOI：

10.7507/1007-4848.202207004

Video：

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Objective To investigate the clinical efficacy of minimally invasive Ivor-Lewis esophagectomy (MIILE) with reverse-puncture anastomosis. Methods Clinical data of the patients with lower esophageal carcinoma who underwent MIILE with reverse-puncture anastomosis in our department from May 2015 to December 2020 were collected. Modified MIILE consisted of several key steps: (1) pylorus fully dissociated; (2) making gastric tube under laparoscope; (3) dissection of esophagus and thoracic lymph nodes under artificial pneumothorax with single-lumen endotracheal tube intubation in semi-prone position; (4) left lung ventilation with bronchial blocker; (5) intrathoracic anastomosis with reverse-puncture anastomosis technique. Results Finally 248 patients were collected, including 206 males and 42 females, with a mean age of 63.3±7.4 years. All 248 patients underwent MIILE with reverse-puncture anastomosis successfully. The mean operation time was 176±35 min and estimated blood loss was 110±70 mL. The mean number of lymph nodes harvested from each patient was 24±8. The rate of lymph node metastasis was 43.1% (107/248). The pulmonary complication rate was 13.7% (34/248), including 6 patients of acute respiratory distress syndrome. Among the 6 patients, 2 patients needed endotracheal intubation-assisted respiration. Postoperative hemorrhage was observed in 5 patients and 2 of them needed hemostasis under thoracoscopy. Thoracoscopic thoracic duct ligation was performed in 1 patient due to the type Ⅲ chylothorax. TypeⅡ anastomotic leakage was found in 3 patients and 1 of them died of acute respiratory distress syndrome. One patient of delayed broncho-gastric fistula was cured after secondary operation. Ten patients with type Ⅰ recurrent laryngeal nerve injury were cured after conservative treatment. All patients were followed up for at least 16 months. The median follow-up time was 44 months. The 3-year survival rate was 71.8%, and the 5-year survival rate was 57.8%. Conclusion The optimized MIILE with reverse-puncture anastomosis for the treatment of lower esophageal cancer is safe and feasible, and the long-term survival is satisfactory.

Citation： FEI Xiang, YANG Lixin, LI Xin, ZHU Ji, JIN Hai, CHEN Hezhong, LU Chaojing. Reverse-puncture anastomosis in minimally invasive Ivor-Lewis esophagectomy for lower esophageal carcinoma: A single-center retrospective study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(3): 364-370. doi: 10.7507/1007-4848.202207004 Copy

1.	Lin Y, Totsuka Y, Shan B, et al. Esophageal cancer in high-risk areas of China: Research progress and challenges. Ann Epidemiol, 2017, 27(3): 215-221.
2.	Lewis I. The surgical treatment of carcinoma of the oesophagus; with special reference to a new operation for growths of the middle third. Br J Surg, 1946, 34: 18-31.
3.	Mitzman B, Lutfi W, Wang CH, et al. Minimally invasive esophagectomy provides equivalent survival to open esophagectomy: An analysis of the National Cancer Database. Semin Thorac Cardiovasc Surg, 2017, 29(2): 244-253.
4.	Omori T, Oyama T, Mizutani S, et al. A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy. Am J Surg, 2009, 197(1): e13-e17.
5.	陆超敬, 杨立信, 陈和忠, 等. CORFLO营养管在胸腔镜IvorLewis食管癌及贲门癌根治术中的应用. 中国胸心血管外科临床杂志, 2016, 23(12): 1154-1157.
6.	Xiao P, Zhuang X, Shen Y, et al. Reverse-puncture anastomotic technique for minimally invasive Ivor-Lewis esophagectomy. Ann Thorac Surg, 2015, 100(6): 2372-2375.
7.	Shen X, Chen T, Shi X, et al. Modified reverse-puncture anastomotic technique vs. traditional technique for total minimally invasive Ivor-Lewis esophagectomy. World J Surg Oncol, 2020, 18(1): 325.
8.	Zhang H, Chen L, Geng Y, et al. Modified anastomotic technique for thoracolaparoscopic Ivor-Lewis esophagectomy: Early outcomes and technical details. Dis Esophagus, 2017, 30(5): 1-5.
9.	Low DE, Alderson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg, 2015, 262(2): 286-294.
10.	Zhang Z, Lin J, Zhuang L, et al. Combined laparoscopic and thoracoscopic Ivor Lewis esophagectomy using the transorally inserted anvil-the experience of Fujian Medical University Union Hospital. J Thorac Dis, 2019, 11(6): 2567-2570.
11.	Zhang R, Kang N, Xia W, et al. Thoracoscopic purse string technique for minimally invasive Ivor Lewis esophagectomy. J Thorac Dis, 2014, 6(2): 148-151.
12.	方勇, 郭卫刚, 谭黎杰, 等. 改良自牵引Overlap法在IvorLewis手术食管胃胸内吻合中的应用价值. 中华消化外科杂志, 2019, 18(3): 274-278.
13.	Dong YN, Zhang L, Sun N, et al. Novel T-shaped linear-stapled intrathoracic esophagogastric anastomosis for minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg, 2015, 99(4): 1459-1463.
14.	Wang WP, Gao Q, Wang KN, et al. A prospective randomized controlled trial of semi-mechanical versus hand-sewn or circular stapled esophagogastrostomy for prevention of anastomotic stricture. World J Surg, 2013, 37(5): 1043-1050.
15.	Peri A, Furbetta N, Viganò J, et al. Technical details for a robot-assisted hand-sewn esophago-gastric anastomosis during minimally invasive Ivor Lewis esophagectomy. Surg Endosc, 2022, 36(2): 1675-1682.
16.	Xie MR, Liu CQ, Guo MF, et al. Short-term outcomes of minimally invasive Ivor-Lewis esophagectomy for esophageal cancer. Ann Thorac Surg, 2014, 97(5): 1721-1727.
17.	史校铭, 陈仕林, 沈晓康, 等. 改良反穿刺吻合技术在全腔镜Ivor Lewis食管癌根治术中消化道重建的应用体会. 中华腔镜外科杂志(电子版), 2020, 13(4): 233-238.
18.	Markar S, Gronnier C, Duhamel A, et al. Pattern of postoperative mortality after esophageal cancer resection according to center volume: Results from a large European multicenter study. Ann Surg Oncol, 2015, 22(8): 2615-2623.
19.	Goense L, Meziani J, Ruurda JP, et al. Impact of postoperative complications on outcomes after oesophagectomy for cancer. Br J Surg, 2019, 106(1): 111-119.
20.	Uchihara T, Yoshida N, Baba Y, et al. Risk factors for pulmonary morbidities after minimally invasive esophagectomy for esophageal cancer. Surg Endosc, 2018, 32(6): 2852-2858.
21.	Lohser J, Slinger P. Lung injury after one-lung ventilation: A review of the pathophysiologic mechanisms affecting the ventilated and the collapsed lung. Anesth Analg, 2015, 121(2): 302-318.
22.	Lai G, Guo N, Jiang Y, et al. Duration of one-lung ventilation as a risk factor for postoperative pulmonary complications after McKeown esophagectomy. Tumori, 2020, 106(1): 47-54.
23.	孙亚林, 孙莉, 李廷坤, 等. 不同气管插管术在胸腹腔镜食管癌根治术中的应用. 中华医学杂志, 2021, 101(9): 630-635.
24.	Lin M, Shen Y, Feng M, et al. Is two lung ventilation with artificial pneumothorax a better choice than one lung ventilation in minimally invasive esophagectomy? J Thorac Dis, 2019, 11(Suppl 5): S707-S712.
25.	Wang J, Hu J, Zhu D, et al. McKeown or Ivor Lewis minimally invasive esophagectomy: A systematic review and meta-analysis. Transl Cancer Res, 2020, 9(3): 1518-1527.
26.	van Workum F, Verstegen MHP, Klarenbeek BR, et al. Intrathoracic vs cervical anastomosis after totally or hybrid minimally invasive esophagectomy for esophageal cancer: A randomized clinical trial. JAMA Surg, 2021, 156(7): 601-610.
27.	Li B, Zhang Y, Miao L, et al. Esophagectomy with three-field versus two-field lymphadenectomy for middle and lower thoracic esophageal cancer: Long-term outcomes of a randomized clinical trial. J Thorac Oncol, 2021, 16(2): 310-317.
28.	Wang S, Chen X, Fan J, et al. Prognostic significance of lymphovascular invasion for thoracic esophageal squamous cell carcinoma. Ann Surg Oncol, 2016, 23(12): 4101-4109.
29.	Ma Y, Yao X, Li Z, et al. The role of vascular invasion and lymphatic invasion in predicting recurrent thoracic oesophageal squamous cell carcinoma. World J Surg Oncol, 2022, 20(1): 12.
30.	Yang H, Liu H, Chen Y, et al. Neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of the esophagus (NEOCRTEC5010): A phase Ⅲ multicenter, randomized, open-label clinical trial. J Clin Oncol, 2018, 36(27): 2796-2803.
31.	Yang H, Liu H, Chen Y, et al. Long-term efficacy of neoadjuvant chemoradiotherapy plus surgery for the treatment of locally advanced esophageal squamous cell carcinoma: The NEOCRTEC5010 randomized clinical trial. JAMA Surg, 2021, 156(8): 721-729.

1. Lin Y, Totsuka Y, Shan B, et al. Esophageal cancer in high-risk areas of China: Research progress and challenges. Ann Epidemiol, 2017, 27(3): 215-221.
2. Lewis I. The surgical treatment of carcinoma of the oesophagus; with special reference to a new operation for growths of the middle third. Br J Surg, 1946, 34: 18-31.
3. Mitzman B, Lutfi W, Wang CH, et al. Minimally invasive esophagectomy provides equivalent survival to open esophagectomy: An analysis of the National Cancer Database. Semin Thorac Cardiovasc Surg, 2017, 29(2): 244-253.
4. Omori T, Oyama T, Mizutani S, et al. A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy. Am J Surg, 2009, 197(1): e13-e17.
5. 陆超敬, 杨立信, 陈和忠, 等. CORFLO营养管在胸腔镜IvorLewis食管癌及贲门癌根治术中的应用. 中国胸心血管外科临床杂志, 2016, 23(12): 1154-1157.
6. Xiao P, Zhuang X, Shen Y, et al. Reverse-puncture anastomotic technique for minimally invasive Ivor-Lewis esophagectomy. Ann Thorac Surg, 2015, 100(6): 2372-2375.
7. Shen X, Chen T, Shi X, et al. Modified reverse-puncture anastomotic technique vs. traditional technique for total minimally invasive Ivor-Lewis esophagectomy. World J Surg Oncol, 2020, 18(1): 325.
8. Zhang H, Chen L, Geng Y, et al. Modified anastomotic technique for thoracolaparoscopic Ivor-Lewis esophagectomy: Early outcomes and technical details. Dis Esophagus, 2017, 30(5): 1-5.
9. Low DE, Alderson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg, 2015, 262(2): 286-294.
10. Zhang Z, Lin J, Zhuang L, et al. Combined laparoscopic and thoracoscopic Ivor Lewis esophagectomy using the transorally inserted anvil-the experience of Fujian Medical University Union Hospital. J Thorac Dis, 2019, 11(6): 2567-2570.
11. Zhang R, Kang N, Xia W, et al. Thoracoscopic purse string technique for minimally invasive Ivor Lewis esophagectomy. J Thorac Dis, 2014, 6(2): 148-151.
12. 方勇, 郭卫刚, 谭黎杰, 等. 改良自牵引Overlap法在IvorLewis手术食管胃胸内吻合中的应用价值. 中华消化外科杂志, 2019, 18(3): 274-278.
13. Dong YN, Zhang L, Sun N, et al. Novel T-shaped linear-stapled intrathoracic esophagogastric anastomosis for minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg, 2015, 99(4): 1459-1463.
14. Wang WP, Gao Q, Wang KN, et al. A prospective randomized controlled trial of semi-mechanical versus hand-sewn or circular stapled esophagogastrostomy for prevention of anastomotic stricture. World J Surg, 2013, 37(5): 1043-1050.
15. Peri A, Furbetta N, Viganò J, et al. Technical details for a robot-assisted hand-sewn esophago-gastric anastomosis during minimally invasive Ivor Lewis esophagectomy. Surg Endosc, 2022, 36(2): 1675-1682.
16. Xie MR, Liu CQ, Guo MF, et al. Short-term outcomes of minimally invasive Ivor-Lewis esophagectomy for esophageal cancer. Ann Thorac Surg, 2014, 97(5): 1721-1727.
17. 史校铭, 陈仕林, 沈晓康, 等. 改良反穿刺吻合技术在全腔镜Ivor Lewis食管癌根治术中消化道重建的应用体会. 中华腔镜外科杂志(电子版), 2020, 13(4): 233-238.
18. Markar S, Gronnier C, Duhamel A, et al. Pattern of postoperative mortality after esophageal cancer resection according to center volume: Results from a large European multicenter study. Ann Surg Oncol, 2015, 22(8): 2615-2623.
19. Goense L, Meziani J, Ruurda JP, et al. Impact of postoperative complications on outcomes after oesophagectomy for cancer. Br J Surg, 2019, 106(1): 111-119.
20. Uchihara T, Yoshida N, Baba Y, et al. Risk factors for pulmonary morbidities after minimally invasive esophagectomy for esophageal cancer. Surg Endosc, 2018, 32(6): 2852-2858.
21. Lohser J, Slinger P. Lung injury after one-lung ventilation: A review of the pathophysiologic mechanisms affecting the ventilated and the collapsed lung. Anesth Analg, 2015, 121(2): 302-318.
22. Lai G, Guo N, Jiang Y, et al. Duration of one-lung ventilation as a risk factor for postoperative pulmonary complications after McKeown esophagectomy. Tumori, 2020, 106(1): 47-54.
23. 孙亚林, 孙莉, 李廷坤, 等. 不同气管插管术在胸腹腔镜食管癌根治术中的应用. 中华医学杂志, 2021, 101(9): 630-635.
24. Lin M, Shen Y, Feng M, et al. Is two lung ventilation with artificial pneumothorax a better choice than one lung ventilation in minimally invasive esophagectomy? J Thorac Dis, 2019, 11(Suppl 5): S707-S712.
25. Wang J, Hu J, Zhu D, et al. McKeown or Ivor Lewis minimally invasive esophagectomy: A systematic review and meta-analysis. Transl Cancer Res, 2020, 9(3): 1518-1527.
26. van Workum F, Verstegen MHP, Klarenbeek BR, et al. Intrathoracic vs cervical anastomosis after totally or hybrid minimally invasive esophagectomy for esophageal cancer: A randomized clinical trial. JAMA Surg, 2021, 156(7): 601-610.
27. Li B, Zhang Y, Miao L, et al. Esophagectomy with three-field versus two-field lymphadenectomy for middle and lower thoracic esophageal cancer: Long-term outcomes of a randomized clinical trial. J Thorac Oncol, 2021, 16(2): 310-317.
28. Wang S, Chen X, Fan J, et al. Prognostic significance of lymphovascular invasion for thoracic esophageal squamous cell carcinoma. Ann Surg Oncol, 2016, 23(12): 4101-4109.
29. Ma Y, Yao X, Li Z, et al. The role of vascular invasion and lymphatic invasion in predicting recurrent thoracic oesophageal squamous cell carcinoma. World J Surg Oncol, 2022, 20(1): 12.
30. Yang H, Liu H, Chen Y, et al. Neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of the esophagus (NEOCRTEC5010): A phase Ⅲ multicenter, randomized, open-label clinical trial. J Clin Oncol, 2018, 36(27): 2796-2803.
31. Yang H, Liu H, Chen Y, et al. Long-term efficacy of neoadjuvant chemoradiotherapy plus surgery for the treatment of locally advanced esophageal squamous cell carcinoma: The NEOCRTEC5010 randomized clinical trial. JAMA Surg, 2021, 156(8): 721-729.

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Reverse-puncture anastomosis in minimally invasive Ivor-Lewis esophagectomy for lower esophageal carcinoma: A single-center retrospective study

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