Major complications of minimally invasive Ivor Lewis oesophagectomy using the purse string-stapled anastomotic technique in 215 patients with oesophageal carcinoma

Kang, Ningning; Zhang, Renquan; Ge, Wei; Si, Panpan; Jiang, Mengdi; Huang, Yunlong; Fang, Yanxin; Yao, L X; Wu, Kaiming

doi:10.1093/icvts/ivy124

Cited by 12 publications

(7 citation statements)

References 21 publications

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“…Kan et al . reported that 39 (18.14%) patients had postoperative pulmonary complications after OrVil anastomosis [ 26 ]. The incidence of postoperative pleural effusion in the two groups of patients was 0.2 (2/10) for the OrVil group and 0.75 (18/24) for the overlap group.…”

Section: Discussionmentioning

confidence: 99%

Selection of two intrathoracic anastomosis methods for transabdominal radical surgery for Siewert type II adenocarcinoma of the esophagogastric junction.

Huang¹,

Liu²,

Zhang³

et al. 2022

Videosurgery and Other Miniinvasive Techniques

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Introduction:The most common intrathoracic anastomosis techniques for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) are the overlap and transorally inserted anvil (OrVil) methods. However, the criteria for choosing between these two methods require further study. Aim: This retrospective study aimed to compare the efficacy and safety of overlap versus OrVil anastomosis in transabdominal radical surgery for Siewert type II adenocarcinoma of the esophagogastric junction. Material and methods: A total of 34 patients with Siewert type II AEG who underwent transabdominal radical surgery and intrathoracic anastomosis with the overlap or OrVil methods at our center from January 2018 to June 2019 were retrospectively analyzed. The relevant surgical and postoperative complication data of the two groups were collected and analyzed. Results: Clinical characteristics: the mean tumor size was 7.5 ±2.4 cm in the OrVil group and 4.3 ±1.9 cm in the overlap group (p < 0.05). Surgery: the distance from the upper resection margin of the esophagus to the tumor was 3.2 ±0.84 cm in the OrVil group and 2.4 ±0.6 cm in the overlap group (p < 0.05). Postoperative complications: there were two cases of pleural effusion in the OrVil group and 18 cases of pleural effusion in the overlap group (p < 0.05). Conclusions: There is no significant difference between the OrVil and overlap anastomosis in terms of the feasibility and safety; however, OrVil anastomosis can provide a higher margin of resection of the esophagus and is suitable for tumors with extensive esophageal invasion.

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Section: Discussionmentioning

confidence: 99%

Selection of two intrathoracic anastomosis methods for transabdominal radical surgery for Siewert type II adenocarcinoma of the esophagogastric junction.

Huang¹,

Liu²,

Zhang³

et al. 2022

Videosurgery and Other Miniinvasive Techniques

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“…Intrathoracic anastomotic leakage has been a serious complication after radical resection of esophageal cancer [9,10]. Improper treatment will induce other serious postoperative complications including thoracic infection, empyema, MODS, and septic shock, and can even be life-threatening in severe cases [11,12]. There are many causes of postoperative anastomotic leakage, including the anatomical characteristics of the esophagus itself, such as no serosal covering of the esophagus, longitudinal muscle fibers, and easy tearing at the same direction of suturing and pulling [13], anastomotic blood supply, and anastomotic tension.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic injection of human fibrin sealant in treatment of intrathoracic anastomotic leakage after esophageal cancer surgery

Chen

Yuan

Chen

et al. 2020

J Cardiothorac Surg

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Objective To investigate the application of endoscopic injection of human fibrin sealant in treatment of patients with intrathoracic anastomotic leakage after esophagectomy. Methods A total of 179 patients who underwent intrathoracic anastomosis after esophageal cancer surgery in our department From December 2012 to May 2015 were retrospectively analyzed. The clinical data and treatment of 7 patients with postoperative intrathoracic anastomotic leakage were analyzed and discussed. On Day 28 after operation, the 7 patients were given endoscopic injection of human fibrin sealant to seal the anastomotic leakage, and the changes in drainage volume, body temperature, CRP, white blood cell count and other indicators were compared before and after endoscopic intervention. Results After endoscopic injection of human fibrin sealant in all 7 patients with intrathoracic anastomotic leakage, the volume of para-anastomotic drainage, CRP, and WBC count were improved compared with those before treatment. Relevant data were analyzed, and the differences were statistically significant (P = 0.019, P = 0.001, P = 0.014, respectively). No statistically significant difference was observed in the body temperature before and after treatment (P = 0.217). Conclusion For patients with intrathoracic anastomotic leakage after esophageal cancer surgery, endoscopic injection of human fibrin sealant to seal the anastomotic leakage has positive therapeutic effects of reducing exudation around the anastomotic leakage, reducing systemic inflammatory response, and improving clinical symptoms including dysphagia, weight loss without trying, chest pain, pressure or burning, worsening indigestion or heartburn and coughing or hoarseness.

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“…(2) The hand-sewn purse-string technique [15][16]: 3-0 suture was used to create a hand-sewn purse string through the muscular layer of the esophagus at least 5 cm proximal to the tumor. A transverse incision was made 2 cm distal to the purse-string suture of the esophagus and the anvil was inserted and fixed by tightening the purse string.…”

Section: Surgery Methodsmentioning

confidence: 99%

The Comparisons of Three Stapler Placement Methods for Intrathoracic Mechanistic Circular Stapling in Ivor Lewis Minimally Invasive Esophagectomy

Zhang

Wang

et al. 2021

Preprint

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Objectives: To analyze the impact of the reversal penetrating technique (RPT) for intrathoracic gastroesophageal mechanical anastomosis on the development of anastomotic complications in Ivor Lewis minimally invasive esophagectomy (ILMIE) and further identify the risk factors for the development of anastomotic leakage and stricture.Methods: A retrospective observational study was conducted using clinical data of 316 patients with esophageal carcinoma (EC) who underwent ILMIE from January 2012 to December 2019. The participants were divided into three groups of RPT, transoral Orvil technique (TOT), or purse-string technique (PST) according to the different stapler placenent methods for intrathoracic mechanistic circular stapling. Multivariable analysis was performed to investigate the association of risk factors with anastomotic leakage and stricture.Results: There were 154 patients with RPT, 78 with TOT and 84 with PST intrathoracic gastroesophageal circular stapling in ILMIE. There was no differences in intraoperative anastomosis related conditions inclouding conversion of open operations, ways of esophageal reconstruction, lymph nodes harvested between the three groups. Whereas, The mean total operative time, and gastroesophageal anastomosis time in the RPT group were significantly shorter than those in other groups (both p<0.05). The rates of anastomotic leakage and stricture showed no statistical differences between three groups, respectively (Leakage: p=0.941; Stricture: p=0.942). Multivariate analysis revealed that the PRT method of the anvil placement does not increase the probability of anastomotic leakage (PRT: reference; TOT: odds ratio(OR) 2.845, P=0.255; PST: OR 2.234, p=0.242) and stricture (PRT: reference; TOT: OR 1.976, P=0.556; PST: OR 1.872, p=0.284).Conclusions: The PRT method of the anvil placement for intrathoracic gastroesophageal circular stapling does not increase the risk of anastomotic complications in ILMIE, but had significantly shorter surgical time and anastomosis time.

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Major complications of minimally invasive Ivor Lewis oesophagectomy using the purse string-stapled anastomotic technique in 215 patients with oesophageal carcinoma

Cited by 12 publications

References 21 publications

Selection of two intrathoracic anastomosis methods for transabdominal radical surgery for Siewert type II adenocarcinoma of the esophagogastric junction.

Selection of two intrathoracic anastomosis methods for transabdominal radical surgery for Siewert type II adenocarcinoma of the esophagogastric junction.

Endoscopic injection of human fibrin sealant in treatment of intrathoracic anastomotic leakage after esophageal cancer surgery

The Comparisons of Three Stapler Placement Methods for Intrathoracic Mechanistic Circular Stapling in Ivor Lewis Minimally Invasive Esophagectomy

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