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Ito S, Ohgaki K, Kawazoe T, Wang H, Okamoto Y, Adachi E, Ikeda Y. Successful Treatment of Refractory Enterocutaneous Fistula After Esophagectomy Using Soft Coagulation by an Endoscopic and Percutaneous Approach: A Case Report. Anticancer Res 2023; 43:2873-2877. [PMID: 37247936 DOI: 10.21873/anticanres.16457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND/AIM Anastomotic leakage (AL) is a serious complication after esophagectomy, and the refractory fistula (RF) following AL is therapeutically challenging with no optimal management strategies known. Thus, new therapeutic options are required for treating RF. CASE REPORT A 67-year-old man who underwent endoscopic mucosal dissection was subjected to subtotal esophagectomy and reconstruction with a gastric tube through the retrosternal route with cervical anastomosis as additional therapy. On postoperative day 5, leakage from the esophagogastric anastomosis was detected. A refractory enterocutaneous fistula (4 cm in length) developed between the esophagogastric anastomosis (the fistula opening was 1 cm approximately) and cervical skin. The RF did not heal despite the drainage of saliva, enteral nutrition, oral administration of biperiden hydrochloride for orofacial dyskinesia to rest the esophagogastric anastomosis, coagulation factor XIII transvenously, and fibrin glue injection from the opening of the fistula, probably due to difficulty in maintaining the rest of the esophagogastric anastomosis caused by orofacial dyskinesia. On postoperative day 76, soft coagulation to the fistula opening at the esophagogastric anastomosis by an endoscopic approach and to the fistula via the fistula opening at the cervical site by a percutaneous approach was performed. The post-treatment course was uneventful. The RF completely closed immediately after soft coagulation. CONCLUSION Soft coagulation using endoscopic and percutaneous approaches to RF is a minimally invasive procedure and may be a useful option if the fistula opening of the anastomotic site is small and accessible endoscopically, and there are no vital organs around the fistula.
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Affiliation(s)
- Shuhei Ito
- Department of Gastrointestinal Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan;
| | - Kippei Ohgaki
- Department of Gastrointestinal Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Tetsuro Kawazoe
- Department of Gastrointestinal Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Huanlin Wang
- Department of Gastrointestinal Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Yasuharu Okamoto
- Department of Gastroenterology, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Eisuke Adachi
- Department of Gastrointestinal Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Yoichi Ikeda
- Department of Gastrointestinal Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
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Soriano C, Wee J. Advances in conduits and anastomotic techniques employed in esophageal cancer resections: A review. J Surg Oncol 2023; 127:228-232. [PMID: 36630091 DOI: 10.1002/jso.27179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 01/12/2023]
Abstract
Esophageal surgery has evolved significantly since the first esophagectomy, with advancements in diagnosis allowing medicine to keep pace with the disease's increasing incidence. Multimodal treatment improves outcomes, but surgical resection remains imperative for local control, with various techniques in existence but none demonstrating clear superiority. More recently, minimally invasive and robotic surgery have further reduced perioperative morbidity. This review discusses techniques for esophageal resection, with attention to the options available for anastomosis and reconstructive conduits.
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Affiliation(s)
- Carlos Soriano
- Department of Thoracic and Cardiac Surgery, The Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jon Wee
- Department of Thoracic and Cardiac Surgery, The Brigham and Women's Hospital, Boston, Massachusetts, USA
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Slaman AE, Eshuis WJ, van Berge Henegouwen MI, Gisbertz SS. Improved anastomotic leakage rates after the "flap and wrap" reconstruction in Ivor Lewis esophagectomy for cancer. Dis Esophagus 2022; 36:6611911. [PMID: 35724430 PMCID: PMC9817821 DOI: 10.1093/dote/doac036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/29/2022] [Indexed: 01/11/2023]
Abstract
Anastomotic leakage after esophagectomy has serious consequences. In Ivor Lewis esophagectomy, a shorter and possibly better vascularized gastric conduit is created than in McKeown esophagectomy. Intrathoracic anastomoses can additionally be wrapped in omentum and concealed behind the pleura ("flap and wrap" reconstruction). Aims of this observational study were to assess the anastomotic leakage incidence after transhiatal esophagectomy (THE), McKeown esophagectomy (McKeown), Ivor Lewis esophagectomy (IL) without "flap and wrap" reconstruction, and IL with "flap and wrap" reconstruction. Consecutive patients undergoing esophagectomy at a tertiary referral center between January 2013 and April 2019 were included. Primary outcome was the anastomotic leakage rate. Secondary outcomes were postoperative outcomes, mortality, and 3-year overall survival. A total of 463 patients were included. The anastomotic leakage incidence after THE (n = 37), McKeown (n = 97), IL without "flap and wrap" reconstruction (n = 39), and IL with "flap and wrap" reconstruction (n = 290) were 24.3, 32.0, 28.2, and 7.2% (P < 0.001). THE and IL with "flap and wrap" reconstruction required fewer reoperations for anastomotic leakage (0 and 1.4%) than McKeown and IL without "flap and wrap" reconstruction (6.2 and 17.9%, P < 0.001). Fewer anastomotic leakages are observed after Ivor Lewis esophagectomy with "flap and wrap" reconstruction compared to transhiatal, McKeown and Ivor Lewis esophagectomy without "flap and wrap" reconstruction. The "flap and wrap" reconstruction seems a promising technique to further reduce anastomotic leakages and its severity in esophageal cancer patients who have an indication for Ivor Lewis esophagectomy.
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Affiliation(s)
- Annelijn E Slaman
- Department of Surgery, Amsterdam UMC location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Wietse J Eshuis
- Department of Surgery, Amsterdam UMC location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Suzanne S Gisbertz
- Address correspondence to: Dr S.S. Gisbertz, Department of Surgery, Amsterdam UMC location AMC, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, AZ 1105, the Netherlands.
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Charalabopoulos A, Davakis S, Syllaios A, Lorenzi B. Intrathoracic hand-sewn esophagogastric anastomosis in prone position during totally minimally invasive two-stage esophagectomy for esophageal cancer. Dis Esophagus 2021; 34:5974937. [PMID: 33179732 DOI: 10.1093/dote/doaa106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 07/26/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022]
Abstract
Utilization of totally minimally invasive esophagectomy for cancer is on the rise. Esophagogastric anastomosis is mechanically or robotically performed routinely; little report exists of hand-sewn esophagogastric anastomosis. This is the largest so far study with thoracoscopic hand-sewn esophagogastric anastomosis during fully minimally invasive two-stage esophagectomy for esophageal cancer in prone position. Consecutive two-stage totally minimally invasive esophagectomies for cancer were performed by one surgical team, from September 2016 to March 2019. All operations were technically identical in terms of patient positioning, surgical approach, extend of lymphadenectomy and type of anastomosis formed. Primary end points were anastomotic leak and anastomotic stricture rate, while secondary end points were 30-day and 90-day mortality rates. From the overall n = 80 patients, n = 67 were males, while n = 13 were females. Mean age was 64.6 years. Mean length of stay was n = 14 days. There were no conversions to open. Mean operating time was 420 minutes with no blood loss over 200 mL noted. Pulmonary and cardiac complication rate was 23.75% and 2.5%, respectively. Anastomotic leak rate was 2.5%. Anastomotic strictures were seen in 12.5% of cases. 30-day and 90-day mortality rate was 2.5% and 5%, respectively, with none accounted for ischemic conduit complications. Intrathoracic anastomosis in totally minimally invasive esophagectomy is challenging and accountable for most of the mortality associated with the procedure. In thoracoscopic two-stage esophagectomy, a mechanical anastomosis is usually preferred; this is believed to be due to the complexity of manual anastomosis associated with the thoracoscopic approach. We aim to present our series of completely hand-sewn intrathoracic anastomosis utilizing a totally minimally invasive approach with favorable outcomes. With this study, reproducibility of the anastomosis is shown that can potentially favor a change in the practice of esophageal surgeons worldwide.
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Affiliation(s)
- Alexandros Charalabopoulos
- Regional Oesophago-Gastric Cancer Centre, Department of Upper Gastrointestinal Surgery, Broomfield Hospital, Chelmsford, Essex, UK.,First Department of Surgery, Laiko General Hospital, Upper Gastrointestinal and General Surgery Unit, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Davakis
- Regional Oesophago-Gastric Cancer Centre, Department of Upper Gastrointestinal Surgery, Broomfield Hospital, Chelmsford, Essex, UK.,First Department of Surgery, Laiko General Hospital, Upper Gastrointestinal and General Surgery Unit, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Syllaios
- First Department of Surgery, Laiko General Hospital, Upper Gastrointestinal and General Surgery Unit, National and Kapodistrian University of Athens, Athens, Greece
| | - Bruno Lorenzi
- Regional Oesophago-Gastric Cancer Centre, Department of Upper Gastrointestinal Surgery, Broomfield Hospital, Chelmsford, Essex, UK
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Abstract
The esophagogastric anastomosis is most commonly performed to restore digestive tract continuity after esophagectomy for cancer. Despite a long history of clinical research and development of high-tech staplers, this procedure is still feared by most surgeons and associated with a 10% leakage rate. Among specific factors that may contribute to failure of the esophageal anastomosis are the absence of serosa layer, longitudinal orientation of muscle fibers, and ischemia of the gastric conduit. It has recently been suggested that the gut microbiome may influence the healing process of the anastomosis through the presence of collagenolytic bacterial strains, indicating that suture breakdown is not only a matter of collagen biosynthesis. The esophagogastric anastomosis can be performed either in the chest or neck, and can be completely hand-sewn, completely stapled (circular or linear stapler), or semi-mechanical (linear stapler posterior wall and hand-sewn anterior wall). Because of the lack of randomized clinical trials, no conclusive evidence is available, and the debate between the hand-sewn and the stapling technique is still ongoing even in the present era of robotic surgery. Centralization of care has improved the overall postoperative outcomes of esophagectomy, but the esophagogastric anastomosis remains the Achille’s heel of the procedure. More research and network collaboration of experts is needed to improve safety and clinical outcomes.
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Affiliation(s)
- Luigi Bonavina
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy
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Halliday LJ, Doran SLF, Sgromo B, Viswanath YKS, Tucker O, Patel B, Jambulingam PS, Dawas K, Mercer S, Baker C, Mughal M, Hanna GB, Moorthy K. Variation in esophageal anastomosis technique-the role of collaborative learning. Dis Esophagus 2020; 33:5610077. [PMID: 31665408 DOI: 10.1093/dote/doz072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Centralization of care has improved outcomes in esophagogastric (EG) cancer surgery. However, specialist surgical centers often work within clinical silos, with little transfer of knowledge and experience. Although variation exists in multiple dimensions of perioperative care, the differences in operative technique are rarely studied. An esophageal anastomosis workshop was held to identify areas of common and differing practice within the operative technique. Surgeons showed videos of their anastomosis technique by open and minimally invasive surgery. Each video was followed by a discussion. Surgeons from 10 different EG cancer centers attended. Eight key technical differences and learning points were identified and discussed: the optimum diameter of the gastric conduit; avoiding ischemia in the gastric conduit; minimizing esophageal trauma; the use of an esophageal mucosal collar; omental wrapping; intraoperative leak testing; ideal diameter of the circular stapler and the growing use of linear stapled anastomoses. The workshop received positive feedback from participants and on 2 years follow-up, 40% stated that they believed that the learning of tips and techniques during the workshop has contributed to lowering their anastomotic leak rate. Many differences exist in surgical technique. The reasons for, and crucially the significance of, these differences must be discussed and examined. Workshops provide a forum for peer-to-peer collaborative learning to reflect on one's own practice and improve surgical technique. These changes can, in turn, generate incremental improvements in patient care and postoperative outcomes.
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Affiliation(s)
- L J Halliday
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - S L F Doran
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - B Sgromo
- Oxford Oesophago Gastric Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Y K S Viswanath
- Department of Surgery, James Cook University Hospital, Middlesborough, UK
| | - O Tucker
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - B Patel
- Upper GI Surgery Unit, The Royal London Hospital, London, UK
| | - P S Jambulingam
- Department of Upper GI Surgery, Luton and Dunstable Hospital, Luton, UK
| | - K Dawas
- Upper Gastrointestinal Surgery, University College London, London, UK
| | - S Mercer
- Department of Upper GI Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - C Baker
- Upper GI Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Mughal
- Upper Gastrointestinal Surgery, University College London, London, UK
| | - G B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - K Moorthy
- Department of Surgery and Cancer, Imperial College London, London, UK
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Liu YJ, Fan J, He HH, Zhu SS, Chen QL, Cao RH. Anastomotic leakage after intrathoracic versus cervical o esophagogastric anastomosis for oesophageal carcinoma in Chinese population: a retrospective cohort study. BMJ Open 2018; 8:e021025. [PMID: 30181184 PMCID: PMC6129039 DOI: 10.1136/bmjopen-2017-021025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate the characteristics and predictors for anastomotic leakage after oesophagectomy for oesophageal carcinoma from the perspective of anastomotic level. DESIGN Retrospective cohort study. SETTINGS A single tertiary medical centre in China. PARTICIPANTS From January 2010 to December 2016, all patients with oesophageal cancer of the distal oesophagus or gastro-oesophageal junction undergoing elective oesophagectomy with a curative intent for oesophageal carcinoma with intrathoracic oesophagogastric anastomosis (IOA) versus cervical oesophagogastric anastomosis (COA) were included. We investigated anastomotic level and perioperative confounding factors as potential risk factors for postoperative leakage by univariate and multivariate logistic regression. PRIMARY OUTCOME MEASURES The primary outcome was the odds of anastomotic leakage by different confounding factors. Secondary outcome was the association of IOA versus COA with other postoperative outcomes. RESULTS Of 458 patients included, 126 underwent cervical anastomosis and 332 underwent intrathoracic anastomosis. Anastomotic leakage developed in 55 patients (12.0%), with no statistical differences between COA and IOA (16.6% vs 10.2%; p=0.058). Multivariable analysis identified active diabetes mellitus (OR 2.001, p=0.047), surgical procedure (open: reference; minimally invasive: OR 1.770, p=0.049) and anastomotic method (semimechanical: reference; stapled: OR 1.821; handsewn: OR 2.271, p=0.048) rather than anastomotic level (IOA: reference; COA: OR 1.622, p=0.110) were independent predictors of leakage. CONCLUSIONS Surgical and anastomotic techniques rather than the level of anastomotic site were independent predictors of postoperative anastomotic leakage in patients undergoing oesophageal cancer surgery.
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Affiliation(s)
- Yin-jiang Liu
- Department of Thoracic Surgery, Taizhou City Hospital of Traditional Chinese Medicine, Taizhou, China
| | - Jun Fan
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huang-he He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shu-sheng Zhu
- Department of Thoracic Surgery, Taizhou City Hospital of Traditional Chinese Medicine, Taizhou, China
| | - Qiu-lan Chen
- Department of Thoracic Surgery, Taizhou City Hospital of Traditional Chinese Medicine, Taizhou, China
| | - Rong-hua Cao
- Department of Thoracic Surgery, Taizhou City Hospital of Traditional Chinese Medicine, Taizhou, China
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8
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Abstract
BACKGROUND Anastomosis in gastrointestinal (GI) surgery is a commonly performed procedure. Irrelevant various methods of intestinal anastomosis were followed - recent advance is the use of a stapler as a device for GI anastomosis. Due to the use of staplers, technical failures are a rarity, anastomosis is more consistent and can be used at difficult locations. MATERIALS AND METHODS : Between 2008 and August 2016, 75 patients with esophagus or gastroesophageal junction carcinoma underwent curative intent resection either via a right posterolateral thoracotomy (TTE) or transhiatal esophagectomy or video-assisted thoracoscopic surgery with linear stapler anastomosis. RESULTS The average follow-up was approximately 9 months. Anastomotic leakage was observed in three patients. On follow-up, two patients presented with difficulty in swallowing, and on upper GI endoscopy, they were found to have anastomotic site stricture. There was no perioperative mortality. CONCLUSION The linear-stapled esophagogastric anastomosis is a safe and effective anastomotic technique, which can decrease the rate of leak, postoperative dysphagia, and anastomotic stricture. As in this technique only two linear staplers are used in comparison to other techniques where three or more staplers are used, it is also cost-effective. The procedure deserves more attention and further application.
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Affiliation(s)
- Parth Kanaiyalal Patel
- Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Mishal Shah
- Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Sanjeev Patni
- Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Shashikant Saini
- Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
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Zhang H, Chen L, Geng Y, Zheng Y, Wang Y. Modified anastomotic technique for thoracolaparoscopic Ivor-Lewis esophagectomy: early outcomes and technical details. Dis Esophagus 2017; 30:1-5. [PMID: 28375449 DOI: 10.1093/dote/dow021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 11/20/2016] [Indexed: 12/11/2022]
Abstract
Thoracoscopic intrathoracic esophagogastrostomy is a technically demanding operation; these technical requirements restrict the extensive application of minimally invasive Ivor-Lewis esophagectomy. In an attempt to reduce the difficulty of this surgical procedure, this study developed a modified anastomotic technique for thoracolaparoscopic Ivor-Lewis esophagectomy. During the entirety of this modified approach, neither technically challenging operations such as intrathoracic suturing or knotting, nor special instruments such as an OrVil system or a reverse-puncture head are required. Between October 2015 and January 2016, 15 consecutive patients with cancer in the distal third of the esophagus or the gastric cardia underwent this modified surgical procedure. The good short-term outcomes that were achieved suggest that the modified anastomotic technique is safe and feasible for thoracolaparoscopic Ivor-Lewis esophagectomy.
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10
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Zhang H, Chen L, Geng Y, Zheng Y, Wang Y. Modified anastomotic technique for thoracolaparoscopic Ivor Lewis esophagectomy: early outcomes and technical details. Dis Esophagus 2017; 30:1-5. [PMID: 27766713 DOI: 10.1111/dote.12534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Thoracoscopic intrathoracic esophagogastrostomy is a technically demanding operation; these technical requirements restrict the extensive application of minimally invasive Ivor Lewis esophagectomy. In an attempt to reduce the difficulty of this surgical procedure, we developed a modified anastomotic technique for thoracolaparoscopic Ivor Lewis esophagectomy. During the entirety of this modified approach, neither technically challenging operations such as intrathoracic suturing, or knotting, nor special instruments such as an OrVil system or a reverse-puncture head are required. Between Octomber 2015 and January 2016, 15 consecutive patients with cancer in the distal third of the esophagus or the gastric cardia underwent this modified surgical procedure. The good short-term outcomes that were achieved suggest that the modified anastomotic technique is safe and feasible for thoracolaparoscopic Ivor Lewis esophagectomy.
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Affiliation(s)
- Hanlu Zhang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Longqi Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yingcai Geng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yun Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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11
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Abstract
The last 25 years have witnessed a steady increase in the use of minimally invasive esophagectomy for the treatment of esophageal cancer. However, it is unclear which the optimal minimally invasive approach is: totally minimally invasive or hybrid (laparoscopic assisted or thoracoscopic assisted)? The current evidence from nonrandomized control trials suggests that hybrid laparoscopic-assisted esophagectomy couples the benefits of laparoscopy and the advantages of thoracotomy, leading to reduced surgical trauma without jeopardizing survival compared with open esophagectomy. Compromised blood supply and tension on the anastomosis are two of the main factors that lead to anastomotic leakage. Recent studies have shown that a side-to-side mechanical intrathoracic esophagogastric anastomosis is associated with low anastomotic complications. This article discusses surgical aspects and outcomes of hybrid laparoscopic-assisted esophagectomy for esophageal cancer.
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Affiliation(s)
- Marco E Allaix
- Department of Surgery, Center for Esophageal Diseases and Swallowing, University of North Carolina , Chapel Hill, North Carolina
| | - Jason M Long
- Department of Surgery, Center for Esophageal Diseases and Swallowing, University of North Carolina , Chapel Hill, North Carolina
| | - Marco G Patti
- Department of Surgery, Center for Esophageal Diseases and Swallowing, University of North Carolina , Chapel Hill, North Carolina
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12
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Qiu B, Feng F, Gao S. Partial esophagogastrostomy with esophagogastric anastomosis below the aortic arch in cardiac carcinoma: characteristics and treatment of postoperative anastomotic leakage. J Thorac Dis 2015; 7:1994-2002. [PMID: 26716038 DOI: 10.3978/j.issn.2072-1439.2015.11.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Anastomotic leakage is a severe and common complication for surgeries of cardiac cancer. Here we explore the clinical features, diagnosis, and treatment strategies of anastomotic leakage in cardiac carcinoma patients after esophagogastric anastomosis. METHODS From January 2009 to December 2013, 1,196 patients with cardiac carcinoma underwent esophagectomy and esophagogastric anastomosis in Cancer Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences. Of them, 25 patients developed symptomatic anastomotic leakage. Their clinical data were retrospectively reviewed. RESULTS Among these 25 patients with anastomotic leakage, three died after active treatment and fifteen healed with thoracic drainage time 18-115 days. The left seven patients who did not heal until discharge developed chronic infection sinus of anastomotic leakage. Without infection symptoms, they were discharged 30-100 days after surgery with nasoenteral tube and thoracic drainage. CONCLUSIONS Anastomotic leakage in cardiac carcinoma patients after esophagogastric anastomosis can be classified into five subtypes: occult type, left thoracic type, right thoracic type, mediastinal type, and mixd type. Subtyping of anastomotic leakage is useful and convenient for diagnosis and treatment.
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Affiliation(s)
- Bin Qiu
- Department of Thoracic Surgery, Cancer Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Feiyue Feng
- Department of Thoracic Surgery, Cancer Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Shugeng Gao
- Department of Thoracic Surgery, Cancer Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100021, China
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13
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Xu M, Liu C, Guo M, Sun X, Sun X, Luo J, Tian J, Jiang X. Combined laparoscopic-thoracoscopic esophagectomy and intrathoracic esophagogastric anastomsis. J Thorac Dis 2014; 5:895-7. [PMID: 24416509 DOI: 10.3978/j.issn.2072-1439.2013.12.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 12/09/2013] [Indexed: 11/14/2022]
Abstract
We retrospectively analyzed the clinical data of 112 patients who underwent esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity from October 2011 to June 2013. First, the gastric tube was created with the aid of linear stapling device by removing the stomach and dissecting lymph nodes under laparoscopy and making a 3-4 cm incision through the subxiphoid area in the upper abdomen. Second, the thoracic esophagus and lymph nodes were dissected during thoracoscopic procedure. Gastric tube was inserted into the chest cavity and placed in the posterior mediastinum. The thoracic gastro-esophageal anastomosis was stapled with a circular stapler. Combined laparoscopic-thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis is technically feasible and safe, with minimized trauma, less operative blood loss and quick recovery.
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Affiliation(s)
- Meiqing Xu
- Department of Thoracic Surgery, the Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China
| | - Changqing Liu
- Department of Thoracic Surgery, the Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China
| | - Mingfa Guo
- Department of Thoracic Surgery, the Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China
| | - Xiangxiang Sun
- Department of Thoracic Surgery, the Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China
| | - Xiaohui Sun
- Department of Thoracic Surgery, the Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China
| | - Jing Luo
- Department of Thoracic Surgery, the Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China
| | - Jieyong Tian
- Department of Thoracic Surgery, the Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China
| | - Xianliang Jiang
- Department of Thoracic Surgery, the Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China
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14
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Shen G, Pan SB, Wu M, Zhang S, Xu XF, Chen G. Use of efficient purse-string stapling technique for esophagogastric anastomosis in minimally invasive Ivor Lewis esophagectomy. J Thorac Dis 2014; 5:898-901. [PMID: 24416510 DOI: 10.3978/j.issn.2072-1439.2013.12.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 12/05/2013] [Indexed: 12/21/2022]
Abstract
Minimally invasive esophagectomy (MIE) is increasingly accepted in the treatment of locoregional or advanced esophageal cancer. Laparoscopic-thoracoscopic Ivor-Lewis esophagectomy has been proved to be effective in treating middle and distal esophageal cancer, however, intrathoracic esophagogastric anastomosis is technically complex. When using circular stapler for making intrathoracic anastomosis in MIE, both transoral and transthoracic methods are frequently used for delivering the anvil into the esophageal stump. Herein, we report a new method to construct a thoracoscopic esophagogastric anastomosis by using a circular stapler: efficient purse-string stapling technique (EST). This technique is easy to handle and especially good to be used in patients with distal esophageal cancer or expanded esophageal cavity.
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Affiliation(s)
- Gang Shen
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, Hangzhou 310009, China
| | - Sai-Bo Pan
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, Hangzhou 310009, China
| | - Ming Wu
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, Hangzhou 310009, China
| | - Sai Zhang
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, Hangzhou 310009, China
| | - Xiao-Fang Xu
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, Hangzhou 310009, China
| | - Gang Chen
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, Hangzhou 310009, China
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Hernández Hernández JR, Navarro Barlés G, López-Tomassetti Fernández EM, Vega Benítez V, Núñez Jorge V. Fistula to the native esophagus after pharyngogastrostomy for malignant disease: A rare phenomenon in esophageal surgery. Thorac Cancer 2013; 4:71-74. [PMID: 28920320 DOI: 10.1111/j.1759-7714.2012.00112.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This article features the case study of a 32-year-old female patient who had undergone surgery to remove a cervical spine tumor and who later developed cervical esophagus necrosis secondary to the erosion caused by an osteosynthesis 13 years after her prosthetic cervical surgery. Barium swallow did not show anything abnormal, but after an emergency spiral computerized axial tomography (CAT) scan, a paravertebral abscess was found, along with displacement of the fixation plate and the disappearance of the esophageal silhouette on coronal sections. The patient underwent surgery to drain the abscess, extract the osteosynthesis materials and the stabilization plates, and to perform a temporary esophageal exclusion. Two months after this surgery the esophagus was reconstructed by performing a retrosternal pharyngogastrostomy without resection of the remaining cervicothoracic esophagus due to severe fibrosis and the absence of local recurrence. During the immediate post operatory period the patient developed a cervical fistula and after a month of conservative treatment, severe dysphagia was observed. Imaging tests showed a spontaneous fistula from the pharynx to the native esophagus, which prompted extraordinary treatment. Therefore, a jejunal loop was taken to the esophagus in the hiatus with a Roux-en-Y anastomosis to resolve this condition.
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Affiliation(s)
- Juan Ramón Hernández Hernández
- Departamento de Cirugía General, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - Gonzalo Navarro Barlés
- Departamento de Cirugía General, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | | | - Victor Vega Benítez
- Departamento de Cirugía General, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - Valentín Núñez Jorge
- Departamento de Cirugía General, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
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