Surgical outcomes following minimally invasive Ivor Lewis esophagectomy do not ultimately depend on the anastomotic technique
EAES Academy. Puccetti F. 07/05/22; 363158; P203
Mr. Francesco Puccetti
Contributions
Contributions
Abstract
Aims:
Ivor Lewis esophagectomy represents the most spread type of esophageal resection. Recent evidence has been increasingly supporting the diffusion and implementation of the minimally invasive technique for esophageal cancer surgery. However, a standardization of the minimally invasive esophagectomy has not been developed. The present study assesses three types of anastomosis techniques performed within a tertiary single-center experience.
Methods:
This retrospective study analyzed a single-center series of consecutive patients submitted to minimally invasive Ivor Lewis esophagectomy from January 2015 to August 2021. Over this period, patients consecutively underwent three different types of anastomotic techniques: entirely linear-stapled Side-to-side (Group 3, 2015-2016), linear-stapled Side-to-side with handsewn closure (Group 2, 2016-2018), and circular-stapled End-to-side esophagogastric anastomosis (Group 1, 2018-nowadays). All linear-stapled Side-to-side techniques were also analyzed jointly as Group 4 and compared to Group 1. The primary endpoint was the occurrence of anastomotic complications, such as anastomotic fistula, conduit necrosis, and trachea-esophageal fistula. All clinical data were mined from an IRB-approved, prospectively maintained institutional database.
Results:
A total of 293 patients underwent minimally invasive Ivor Lewis esophagectomy according to the above-mentioned anastomotic techniques: Group 1 (206 patients), Group2 (43), and Group 3 (44). The study population did not show statistically significant differences between groups' demographics, although longitudinal changes in management and surgical practice led to different median operative times, lymph node harvest, and proportions of patients being submitted to neoadjuvant therapy. Rates of severe anastomotic complications, either the anastomotic fistula or conduit necrosis, were not statistically different between groups, although tracheoesophageal fistula appeared to be significantly associated with Group 1. On the other hand, the anastomotic technique did not impact the overall postoperative morbidity, as well as the length of hospital stay and 30-day readmission. As a bias due to the establishment of the minimally invasive technique as our institutional gold standard for esophageal resections, increasing 90-day mortality was noted over time.
Conclusions:
The technique of esophagogastric anastomosis cannot exclusively guarantee the goodness of final surgical outcomes. Other etiological causes should be sought among more relevant and comprehensive perioperative factors, such as stable hemodynamics over the earliest postoperative days.
Ivor Lewis esophagectomy represents the most spread type of esophageal resection. Recent evidence has been increasingly supporting the diffusion and implementation of the minimally invasive technique for esophageal cancer surgery. However, a standardization of the minimally invasive esophagectomy has not been developed. The present study assesses three types of anastomosis techniques performed within a tertiary single-center experience.
Methods:
This retrospective study analyzed a single-center series of consecutive patients submitted to minimally invasive Ivor Lewis esophagectomy from January 2015 to August 2021. Over this period, patients consecutively underwent three different types of anastomotic techniques: entirely linear-stapled Side-to-side (Group 3, 2015-2016), linear-stapled Side-to-side with handsewn closure (Group 2, 2016-2018), and circular-stapled End-to-side esophagogastric anastomosis (Group 1, 2018-nowadays). All linear-stapled Side-to-side techniques were also analyzed jointly as Group 4 and compared to Group 1. The primary endpoint was the occurrence of anastomotic complications, such as anastomotic fistula, conduit necrosis, and trachea-esophageal fistula. All clinical data were mined from an IRB-approved, prospectively maintained institutional database.
Results:
A total of 293 patients underwent minimally invasive Ivor Lewis esophagectomy according to the above-mentioned anastomotic techniques: Group 1 (206 patients), Group2 (43), and Group 3 (44). The study population did not show statistically significant differences between groups' demographics, although longitudinal changes in management and surgical practice led to different median operative times, lymph node harvest, and proportions of patients being submitted to neoadjuvant therapy. Rates of severe anastomotic complications, either the anastomotic fistula or conduit necrosis, were not statistically different between groups, although tracheoesophageal fistula appeared to be significantly associated with Group 1. On the other hand, the anastomotic technique did not impact the overall postoperative morbidity, as well as the length of hospital stay and 30-day readmission. As a bias due to the establishment of the minimally invasive technique as our institutional gold standard for esophageal resections, increasing 90-day mortality was noted over time.
Conclusions:
The technique of esophagogastric anastomosis cannot exclusively guarantee the goodness of final surgical outcomes. Other etiological causes should be sought among more relevant and comprehensive perioperative factors, such as stable hemodynamics over the earliest postoperative days.
Aims:
Ivor Lewis esophagectomy represents the most spread type of esophageal resection. Recent evidence has been increasingly supporting the diffusion and implementation of the minimally invasive technique for esophageal cancer surgery. However, a standardization of the minimally invasive esophagectomy has not been developed. The present study assesses three types of anastomosis techniques performed within a tertiary single-center experience.
Methods:
This retrospective study analyzed a single-center series of consecutive patients submitted to minimally invasive Ivor Lewis esophagectomy from January 2015 to August 2021. Over this period, patients consecutively underwent three different types of anastomotic techniques: entirely linear-stapled Side-to-side (Group 3, 2015-2016), linear-stapled Side-to-side with handsewn closure (Group 2, 2016-2018), and circular-stapled End-to-side esophagogastric anastomosis (Group 1, 2018-nowadays). All linear-stapled Side-to-side techniques were also analyzed jointly as Group 4 and compared to Group 1. The primary endpoint was the occurrence of anastomotic complications, such as anastomotic fistula, conduit necrosis, and trachea-esophageal fistula. All clinical data were mined from an IRB-approved, prospectively maintained institutional database.
Results:
A total of 293 patients underwent minimally invasive Ivor Lewis esophagectomy according to the above-mentioned anastomotic techniques: Group 1 (206 patients), Group2 (43), and Group 3 (44). The study population did not show statistically significant differences between groups' demographics, although longitudinal changes in management and surgical practice led to different median operative times, lymph node harvest, and proportions of patients being submitted to neoadjuvant therapy. Rates of severe anastomotic complications, either the anastomotic fistula or conduit necrosis, were not statistically different between groups, although tracheoesophageal fistula appeared to be significantly associated with Group 1. On the other hand, the anastomotic technique did not impact the overall postoperative morbidity, as well as the length of hospital stay and 30-day readmission. As a bias due to the establishment of the minimally invasive technique as our institutional gold standard for esophageal resections, increasing 90-day mortality was noted over time.
Conclusions:
The technique of esophagogastric anastomosis cannot exclusively guarantee the goodness of final surgical outcomes. Other etiological causes should be sought among more relevant and comprehensive perioperative factors, such as stable hemodynamics over the earliest postoperative days.
Ivor Lewis esophagectomy represents the most spread type of esophageal resection. Recent evidence has been increasingly supporting the diffusion and implementation of the minimally invasive technique for esophageal cancer surgery. However, a standardization of the minimally invasive esophagectomy has not been developed. The present study assesses three types of anastomosis techniques performed within a tertiary single-center experience.
Methods:
This retrospective study analyzed a single-center series of consecutive patients submitted to minimally invasive Ivor Lewis esophagectomy from January 2015 to August 2021. Over this period, patients consecutively underwent three different types of anastomotic techniques: entirely linear-stapled Side-to-side (Group 3, 2015-2016), linear-stapled Side-to-side with handsewn closure (Group 2, 2016-2018), and circular-stapled End-to-side esophagogastric anastomosis (Group 1, 2018-nowadays). All linear-stapled Side-to-side techniques were also analyzed jointly as Group 4 and compared to Group 1. The primary endpoint was the occurrence of anastomotic complications, such as anastomotic fistula, conduit necrosis, and trachea-esophageal fistula. All clinical data were mined from an IRB-approved, prospectively maintained institutional database.
Results:
A total of 293 patients underwent minimally invasive Ivor Lewis esophagectomy according to the above-mentioned anastomotic techniques: Group 1 (206 patients), Group2 (43), and Group 3 (44). The study population did not show statistically significant differences between groups' demographics, although longitudinal changes in management and surgical practice led to different median operative times, lymph node harvest, and proportions of patients being submitted to neoadjuvant therapy. Rates of severe anastomotic complications, either the anastomotic fistula or conduit necrosis, were not statistically different between groups, although tracheoesophageal fistula appeared to be significantly associated with Group 1. On the other hand, the anastomotic technique did not impact the overall postoperative morbidity, as well as the length of hospital stay and 30-day readmission. As a bias due to the establishment of the minimally invasive technique as our institutional gold standard for esophageal resections, increasing 90-day mortality was noted over time.
Conclusions:
The technique of esophagogastric anastomosis cannot exclusively guarantee the goodness of final surgical outcomes. Other etiological causes should be sought among more relevant and comprehensive perioperative factors, such as stable hemodynamics over the earliest postoperative days.
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