[Eduard Nikitich Vantsian: to the 100th anniversary of the birth]

One hundred and one years ago Eduard Nikitich Vantsyan (1921-1989), an outstanding Soviet surgeon, B.V. Petrovsky's pupil, Doctor of Medicine, Professor, Corresponding Member of the USSR Academy of Medical Sciences, was born (Fig. 1). He was the author of more than 120 scientific works and 6 monographs devoted to the study of motor function and surgery of the esophagus, conservative treatment of its constrictions and cardiospasm, diseases of the operated esophagus. He had developed methods of total and segmental plasty of the esophagus, treatment of hernias of the esophageal aperture of the diaphragm and diverticula of the esophagus. He supervised 26 dissertations, including 12 doctoral theses. Eduard Nikitich is considered one of the founders of esophageal and diaphragm surgery.

[Reconstructive esophageal surgery in fast track epoch]

OBJECTIVE

To evaluate an efficiency and safety of perioperative fast track management in reconstructive esophageal surgery.

MATERIAL AND METHODS

Perioperative fast track management protocol in reconstructive esophageal surgery has been applied since 2014 at the Department of Thoracoabdominal Surgery and Oncology of the Petrovsky Russian Scientific Center of Surgery. These patients (2017-2020) were included in the main group (n=75). Patients who underwent traditional perioperative care (2010-2013) were enrolled in the control group (n=63). The primary outcome was postoperative hospital-stay. We also evaluated ICU stay, incidence of complications according to Clavien-Dindo grading system with particular registration of respiratory complications, mortality, enteral and oral feeding onset.

RESULTS

There were no significant between-group differences in sex, age, ASA grade, body mass index. Fast track management reduced hospital-stay from 14 (12; 17) days in the control group to 11 (8; 22) days in the main group (p=0.008). Mean ICU-stay decreased up to 1 (0.8; 2) day in the main group compared to the control group (4.1 (3.5; 5.6) days, p<0.0001). Pneumonia was noted in 5 patients after fast track recovery and 15 patients in the control group (p=0.004). No patients died in the main group, 3 (4.8%) patients - in the control group (p=1).

CONCLUSION

Modern perioperative fast track management protocol is safe and effective for extensive reconstructive esophageal interventions. This approach reduces hospital-stay and ICU stay, as well as the incidence of respiratory complications.

[Initial experience of robot-assisted minimally invasive McKeown esophagectomy]

OBJECTIVE

To report our initial experience of robot-assisted McKeown esophagectomy with stapled cervical esophagogastrostomy.

MATERIAL AND METHODS

There were 5 robot-assisted McKeown esophagectomies in patients with benign end-staged and malignant diseases of the esophagus for the period from October 2019 to February 2020.

RESULTS

No conversions and intraoperative complications were observed. Mean surgery time was 406±48 min, total intraoperative blood loss - 108±45 ml. Four patients had minor complications (wound infection, atelectasis, pneumothorax) that required conservative treatment. We have controlled anastomosis in 2-3 postoperative days with water-soluble contrast, none patient had an anastomotic leakage. Mean hospital-stay was 5 days. Complete (R0) resection was accomplished in all patients with malignant neoplasms.

CONCLUSIONS

Our first experience showed that robot-assisted McKeown esophagectomy is a safe and feasible surgical option for esophageal diseases. Robot-assisted interventions require advanced endoscopic surgical experience.

MECHANICAL ESOPHAGEAL ANASTOMOSES

This article gives an overview of mechanical esophageal anastomosis. The results of the esophageal anastomoses formation by using circular and linear stitching devices (staplers) by Russian and foreign authors are presented in chronological order. The faults of staplers, complications associated with them are described. The importance of the problem related to the choice of anastomotic technique to reduce the risks of specific complications such as leakage and stricture of esophageal anastomosis was remarked by authors. The advantages and disadvantages of the currently known esophageal anastomotic methods have been analyzed. It was noted that mechanical side-to-side anastomoses are associated with low frequency of leakage, stricture, postoperative mortality, that’s why they have become preferable, especially in the mini-invasive reconstructive surgery. The authors concluded that the question about the feasibility of mechanical esophageal anastomoses formation is not answered, the evaluation of the properties of modern staplers and the search for the best esophageal anastomotic method are relevant for modern surgery.