Objective To evaluate the safety and advantage in lymph node dissection of Ivor-Lewis esophagectomy in patients with esophageal cancer. Methods Clinical and pathological data of 78 patients with esophageal cancer who underwent Ivor-Lewis esophagectomy between September 2012 and March 2014 were collected and analyzed. Another 86 esophageal cancer patients who underwent esophagectomy of Sweet procedure during the same period were regarded as the controls. Duration of surgery, intra-operative blood loss, incidence of main complications and positive rate of lymph node were compared between the two groups. Results The duration of surgery in Ivor-Lewis group [(254.5±38.4) minutes] was longer than that in the Sweet group [(216.7±31.3) minutes]; and the average intra-operative blood loss in Ivor-Lewis group [(165.5±40.3) mL] was higher than that in the Sweet group [(148.7±35.4) mL]; the differences were significant (P < 0.01). Incidence of hoarseness in Ivor-Lewis group was significantly higher than that in Sweet group (P < 0.05), while incidences of other comp lications between the two groups were similar (P > 0.05). The proportion of patients with positive lymph nodes in Ivor-Lewis group (60.3%, 47/78) was significantly higher than that in Sweet group (26.7%, 23/86) (P < 0.05). Average number of lymph nodes dissected in Ivor-Lewis group (21.5±5.3) was significantly higher than that in Sweet group (10.6±4.1). Lymph nodes along the right recurrent laryngeal nerve was the most common metastasis in patients of Ivor-Lewis group, while lymph nodes in that area in Sweet group patients could hardly be dissected. Conclusions Ivor-Lewis esophagectomy is a safe surgical procedure for esophageal cancer. Ivor-Lewis procedure has more advantages in lymph node dissection than Sweet procedure.
Surgery is the preferred treatment for early esophageal cancer. Minimally invasive esophagectomy (MIE) can significantly reduce the incidence of postoperative complications and mortality, but due to the complex esophageal anatomy, intraoperative esophageal exposure, separation, anastomosis and lymph node dissection are difficult. The da Vinci surgical system provides a 3D vision and a more flexible as well as stable robotic arm, which is very helpful in completing fine surgical procedures. Robot-assisted minimally invasive esophagectomy(RAMIE) has been carried out in a number of countries, including China. Robot-assisted Ivor-Lewis esophagectomy (RAILE) is a transthoracic approach of robots developed in recent years. This paper summarizes the current researches on RAILE.
Objective To compare the short-term efficacy of Ivor-Lewis via hand-sewn purse-string approach and purse-string forceps approach in minimally invasive esophagectomy for middle and lower esophageal cancer, and to discuss the safety and feasibility of hand-sewn purse-string anastomosis technique for minimally invasive Ivor-Lewis esophagectomy (MIILE). Methods The clinical data of 151 patients undergoing thoracoscopic and laparoscopic esophageal cancer surgery from January 2014 to January 2017 in our hospital were retrospectively analyzed. According to the different methods of purse string making, the patients were divided into a purse-string forceps group including 49 males and 16 females with a mean age of 67.98±7.07 years ranging from 51 to 80 years treated with forceps to make purse-string and a handcraft group including 61 males and 25 females with a mean age of 67.76±8.18 years ranging from 52 to 83 years using hand-sewn way. The perioperative data of two two groups were compared. Results The purse-string making time and postoperative total volume of chest drainage were less in the handcraft group than those in the purse-string forceps group (P<0.05). There was no significant difference between the two groups in hemorrhage during operation, the operation duration or postoperative hospital stay (P>0.05). There was also no statistical difference between the two groups in the rate of anastomotic or gastric tube fistula, anastomotic stenosis, pulmonary infection or incision infection (P>0.05). Conclusion In minimally invasive esophagectomy for middle-lower section, MIILE by hand-sewn purse-string is as safe as purse-string forceps, with no more complications, needing no professional equipments, and easy to learn, master and promote.
ObjectiveTo compare the clinical efficacy of modified Ivor-Lewis esophagectomy, which preserves azygos vein, thoracic duct and peripheral tissues, and classic Ivor-Lewis esophagectomy, which resects these tissues, in the treatment of esophageal cancer, so as to evaluate whether it is necessary to resect azygos vein, thoracic duct and peripheral tissues in esophagectomy for esophageal cancer.MethodsPatients scheduled for surgical treatment of thoracic esophageal cancer in Department of Thoracic Surgery of Sichuan Cancer Hospital from June 2011 to June 2013 were randomly assigned to the retention group and the resection group, each including 100 patients. The retention group included 87 males and 13 females with an average age of 60.53±7.72 years. In the resection group, there were 80 males and 20 females with an average age of 60.69±7.69 years. Patients in the two groups were compared for the duration of surgery, intraoperative blood loss, postoperative thoracic drainage volume, postoperative complications, and number of dissected lymph nodes, etc. Postoperative relapse and survival rates at 1, 3 and 5 years postoperatively were also followed up and compared for patients in the two groups.ResultsThere was no statistical difference between the two groups in general patient characteristics, number of dissected lymph nodes, or postoperative pathological stage, etc. (P>0.05). Compared to the resection group, there were shorter duration of surgery, less intraoperative blood loss, and less thoracic drainage volume in the first 3 days following surgery in the retention group, with statistical differences (P<0.05). There was no statistical difference between the two groups in type or site of relapse or metastasis (P>0.05). The survival rates at 1, 3, and 5 years postoperatively was 78.7% vs. 81.3%, 39.4% vs. 37.5%, and 23.4% vs. 17.7%, respectively, in the retention group and the resection group, with no statistical difference (P>0.05).ConclusionModified Ivor-Lewis esophagectomy preserving azygos vein, thoracic duct and peripheral tissues could reduce surgical trauma, would not increase postoperative relapse or metastasis, and could produce long-term efficacy comparable to that of extended resection.
At present, the application of the robot assisted surgery system in the surgical treatment of esophageal cancer is gradually emerging, and it is more and more widely used and recognized in the field of surgery. According to the domestic and foreign literatures, the robot has many advantages, and robotic assisted esophageal cancer surgery has been proved to be safe and effective, and its short-term efficacy is significantly better than thoracotomy. Other studies have shown that in long-term follow-up, the effect is comparable to video-assisted thoracoscopic surgery. In this paper, the author are systematically reviewed the development history of the robot assisted surgery system, the effect of robotic assisted esophagectomy on safety, surgical method, short-term efficacy and long-term prognosis. The traditional open surgery and thoracoscopic laparoscopic esophagectomy has been carried on the detailed comparison to provide some advice and theoretical basis for esophageal cancer surgery robot system.
Surgery is an important method in the treatment of esophageal cancer. With the application of robotic surgery system, more and more surgeons have observed its huge advantages over the conventional minimally invasive surgical system in the esophageal surgery. To ensure the safety and fluency of the robotic surgery, it needs not only an experienced attending surgeon but also a well-trained assistant. This study summaries the skills of the surgical assistant in the robotic esophagectomy.
ObjectiveTo investigate the effect of jejunostomy combined with Ivor-Lewis or McKeown operation on the treatment of middle and lower esophageal cancer.MethodsThe clinical data of 127 patients with middle and lower esophageal cancer admitted to our hospital from June 2018 to October 2019 were retrospectively analyzed, including 89 males and 38 females, aged 62.82±8.65 years. The patients were divided into an Ivor-Lewis group (IL group, 72 patients) and a McKeown group (MK group, 55 patients) according to surgical methods. Patients in the IL group received jejunostomy combined with Ivor-Lewis operation, and patients in the MK group received jejunostomy combined with McKeown operation. The operation time, postoperative bedside electrical impedance tomography (EIT) parameters, postoperative inflammatory factor levels, postoperative complications and rehabilitation of the two groups were compared.ResultsThe operation time (262.65±49.78 min vs. 303.04±60.13 min), postoperative eating time (10.54±2.22 d vs. 11.47±2.49 d) and postoperative hospital stay (14.78±2.47 d vs.15.72±2.36 d) in the IL group were significantly shorter than those in the MK group (P<0.05). The blood loss (156.13±52.43 mL vs. 158.87±48.47 mL) and the number of lymph node dissection (29.47±8.88 vs. 30.17±9.80) in the IL group were less than those in the MK group, but the differences were not statistically significant (P>0.05). The repeated measurement analysis of variance showed that the time point could significantly affect tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and IL-8 levels (Ftime point=520.543, 272.379, 147.688, all P<0.05), but the surgical methods and the interactive effect of time point and surgical methods did not affect the levels of TNF-α, IL-6 and IL-8 (P>0.05). Postoperative bedside EIT image parameters were statistically different on the postoperative 1 d, 3 d, 5 d and 7 d between the two groups (P<0.05). Compared with the MK group, the incidences of recurrent laryngeal nerve injury, arrhythmia, pulmonary infection and atelectasis, anastomotic leakage, gastric wall necrosis and stump fistula, secondary thoracotomy and abdominal hemostasis, and intestinal obstruction were lower, but the differences were not statistically different (P>0.05). The recurrence rate of patients in the IL group within 6 months was lower than that in the MK group, but the difference was not statistically significant (8.33% vs. 9.09%, P>0.05).ConclusionJejunostomy combined with Ivor-Lewis or McKeown surgery have equivalent effects on patients with middle and lower esophageal cancer.
ObjectiveTo investigate the clinical efficacy of minimally invasive Ivor-Lewis esophagectomy (MIILE) with reverse-puncture anastomosis. MethodsClinical 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%. ConclusionThe optimized MIILE with reverse-puncture anastomosis for the treatment of lower esophageal cancer is safe and feasible, and the long-term survival is satisfactory.
Objective To evaluate the application effect of modified jejunostomy in thoracoscopic Ivor-Lewis esophagectomy. Methods A retrospective analysis of patients who underwent Ivor-Lewis esophagectomy for middle and lower esophageal cancer from 2017 to 2023 in our department was performed. The patients from 2017 to 2020 receiving "C+I" in the upper jejunum according to the "C+I" model, and fistula fixed with only two purse-string sutures and the abdominal wall were allocated into a group A. The patients from 2021 to 2023, on the basis of "C+I" suture, the jejunum and abdominal wall fixed with 3-0 absorbable thread for 1-2 needles at the proximal or distal end of the fistula 10-15 mm, and the upper jejunum and abdominal wall fixed into "curtain" were allocated into a group B. The operation time, jejunostomy time, postoperative pathological stage, and enteral nutrition-related complications such as the incidence of incomplete intestinal obstruction, closed loop intestinal obstruction and intestinal volvulus requiring secondary surgery, skin redness and swelling of intestinal fluid leakage, stoma tube blockage, and accidental extubation were compared between the two groups. Results All patients successfully completed Ivor-Lewis esophagectomy under thoracoscopy. There was no perioperative death. There were 118 patients in the group A, including 72 males and 46 females, with an average age of 64.58±6.30 years. There were 125 patients in the group B, including 76 males and 49 females, with an average age of 65.11±6.81 years. There was no statistical difference in operation time, jejunal fistula time, fistula blockage or accidental extubation rate between the two groups (P>0.05). There was a statistical difference in the incidence of incomplete intestinal obstruction (P=0.035), and closed loop intestinal obstruction requiring secondary surgery (P=0.017). There were 36 patients of eczema-like changes in the patients with severe intestinal leakage and redness in the group A, and 7 patients of intestinal leakage and redness in the group B (P<0.001). Conclusion The modified jejunostomy can significantly reduce the incomplete intestinal obstruction, closed loop intestinal obstruction and secondary operation rate after "C+I" jejunostomy, and significantly improve the leakage of intestinal fluid at the stoma and the injury of surrounding skin and soft tissue. Improvements in certain technologies reduce operational difficulties and is worthy of promotion and application in clinical practice.
目的 探讨腹腔镜胃微创游离术在食管癌Ivor-Lewis术式的应用价值。 方法 回顾性分析2009年4月－2011年1月行Ivor-Lewis术式食管癌患者25例，其中男15例，女10例，年龄50～72岁，平均63岁，食管中段癌14例，食管下段癌11例，腹部操作均采用经脐部、右腋前线平胆囊底水平、左腋前线平左侧肋缘及前述两操作孔与脐部连线中点做操作孔置入腹腔镜器械，超声刀游离胃并清扫腹腔淋巴结。 结果 25例手术均取得成功,无中转开腹。腹腔镜操作时间30~80 min;出血约2~20 mL，无术中输血；行胃左动脉、肝总动脉、腹腔干动脉、胃大、小弯及贲门旁淋巴结完全清扫,术后患者2～4 d肛门排气,术后5～7 d恢复进食，术后住院9～12 d ；25例患者随访1～2年，进食及生活质量良好，无复发转移及死亡者。 结论 食管癌Ivor-Lewis术式中采用腹腔镜胃微创游离术是安全可行的，可充分游离胃、腹腔淋巴结清扫彻底同时具有减少手术创伤、出血少、疼痛轻、术后并发症少、住院时间减少等优点，值得推广。