Reverse-puncture anastomosis in minimally invasive Ivor-Lewis esophagectomy for lower esophageal carcinoma:A single-center retrospective study
Objective To investigate the clinical efficacy of minimally invasive Ivor-Lewis esophagectomy(MIILE)with reverse-puncture anastomosis.Methods Clinical 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.Type Ⅱ 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％.Conclusion The optimized MIILE with reverse-puncture anastomosis for the treatment of lower esophageal cancer is safe and feasible,and the long-term survival is satisfactory.
万方数据
维普
