JSLS : Journal of the Society of Laparoendoscopic Surgeons · 2025
Modified Minimally Invasive Ivor-Lewis Esophagectomy with Trans-Hiatal Esophageal Transection.
СтатьяНазвание и аннотация: Перевод в очереди
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Marchesi Federico, Valente Marina, Tartamella Francesco, Cecconi Sara, Resina Elisa, de Robertis Federica, Cancilla Valerio, Dalmonte Giorgio
Аннотация
BACKGROUND: Totally minimally invasive Ivor-Lewis esophagectomy (ILMIE) is a particularly challenging procedure. Despite recent improvements, technical difficulties, mainly in creating intrathoracic anastomosis, still account for a high rate of anastomotic leaks. We present a modified ILMIE technique, with a transhiatal esophageal transection during the laparoscopic stage, aimed at facilitating the thoracoscopic approach and overcoming some of its pitfalls.
METHODS: Twenty-four consecutive patients with Siewert I and Siewert II esophago-gastric junction tumors with a 8 cm maximum involvement of distal esophagus were included in the study and underwent modified ILMIE with transhiatal esophageal transection and transabdominal (Pfannestiel) specimen extraction. A frozen section examination of specimen margin was obtained while repositioning the patients for thoracoscopic access in prone position. An end-to-side mechanical anastomosis, reinforced by a 3-0 running suture, was performed.
RESULTS: There were no major intraoperative complications. Eleven patients (45.8%) had a Clavien-Dindo grade higher than 2 postoperative complication, including one (4.2%) type II anastomotic leak. The mean number of harvested lymph nodes was 31.5 ± 17.2 and we recorded 1 R1 resection (4.2%). Disease free survival rate at 1 year, irrespective of the pathologic stage, was 67%.
CONCLUSIONS: Modified ILMIE seems to be a safe alternative to the traditional technique. Transabdominal specimen extraction allows a reduced minithoracotomy, a better thoracoscopic workspace and early availability of a frozen section for examination. Larger series are needed to assess possible benefits on postoperative and oncological outcomes.
METHODS: Twenty-four consecutive patients with Siewert I and Siewert II esophago-gastric junction tumors with a 8 cm maximum involvement of distal esophagus were included in the study and underwent modified ILMIE with transhiatal esophageal transection and transabdominal (Pfannestiel) specimen extraction. A frozen section examination of specimen margin was obtained while repositioning the patients for thoracoscopic access in prone position. An end-to-side mechanical anastomosis, reinforced by a 3-0 running suture, was performed.
RESULTS: There were no major intraoperative complications. Eleven patients (45.8%) had a Clavien-Dindo grade higher than 2 postoperative complication, including one (4.2%) type II anastomotic leak. The mean number of harvested lymph nodes was 31.5 ± 17.2 and we recorded 1 R1 resection (4.2%). Disease free survival rate at 1 year, irrespective of the pathologic stage, was 67%.
CONCLUSIONS: Modified ILMIE seems to be a safe alternative to the traditional technique. Transabdominal specimen extraction allows a reduced minithoracotomy, a better thoracoscopic workspace and early availability of a frozen section for examination. Larger series are needed to assess possible benefits on postoperative and oncological outcomes.