Minimally Invasive Esophagectomy Utilizing a Stapled Side-to-Side Anastomosis is Safe in the Western Patient Population

• Published in: Annals of surgical oncology 2016-09, Vol.23 (9), p.3056-3062
• Main Authors: Ben-David, Kfir, Tuttle, Rebecca, Kukar, Moshim, Rossidis, Georgios, Hochwald, Steven N.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Anastomosis, Surgical; Anastomotic Leak - epidemiology; Comorbidity; Esophageal Neoplasms - mortality; Esophageal Neoplasms - surgery; Esophagectomy - methods; Esophagectomy - mortality; Female; Hospital Mortality; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgical Procedures; Oncology; Postoperative Complications - epidemiology; Retrospective Studies; Surgery; Surgical Oncology; Surgical Stapling; Thoracic Oncology; United States
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-016-5232-1

Background There has been an increased utilization of minimally invasive esophagectomy (MIE) in an effort to reduce morbidity, decrease length of stay, and improve quality of life. However, there are limited large series of patients undergoing MIE from the United States and no standardized approach. We reviewed our experience with MIE utilizing a stapled side-to-side anastomosis during a 7.5-year period. Study Design A retrospective review of prospectively maintained databases for patients undergoing planned esophagectomy were reviewed from 2007 to 2015. Esophagogastric anastomoses were performed via a 6-cm linear stapled side-to-side method. Demographics, comorbidities, surgical approach, pathology data, and postoperative morbidities were recorded and reviewed. Results A MIE was attempted in 303 of 315 (96 %) patients, and a total minimally invasive approach was completed in 293 of 315 (93 %) patients. Location of anastomosis was predominantly in the neck, with 244 patients (77.5 %) undergoing a total minimally invasive McKeown approach ( n  = 231). A total, minimally invasive Ivor-Lewis was completed in 60 patients (19.1 %). Anastomotic leak was identified in 24 patients (7.6 %). Rates of anastomotic leak were 4.4 % for Ivor-Lewis and 8.5 % for McKeown resection. Median length of stay was 8 days, and in-hospital mortality occurred in only three patients ( n  = 1 %). Ninety-day follow-up demonstrated a 4.1 % stricture rate requiring dilatation. Conclusions In the Western patient population, MIE utilizing a 6-cm stapled side-to-side anastomosis is associated with low rates of anastomotic leak, stricture, and mortality.