Laparothoracoscopic esophagectomy type Ivor Lewis with the formation of an intrapleural non-hardware esophageal-gastric anastomosis in case of esophageal cancer: immediate results

Radical surgeries remain the main treatment for resectable esophageal cancer. Among them, one of the most progressive option is to perform an esophagectomy with laparothoracoscopic access with the formation of an intrapleural anastomosis with a mechanical or non-hardware suture, each variant of which has its advantages and disadvantages.

Purpose: to conduct a comparative analysis of the direct results of laparothoracoscopic esophagectomy according to the Ivor Lewis type with the formation of a non-hardware esophageal-gastric intrapleural anastomosis with the traditional Ivor Lewis operation.

Methods. A retrospective and prospective clinical study was carried out, including 60 patients operated on for esophageal cancer and cardioesophageal cancer of types I and II according to Siewert classification (level of evidence II).

Results. Compared with “open” esophagectomy (OE), the duration of LTSE is 136.57 minutes longer (p=0.012); the duration of anesthesia and mechanical ventilation is 77.5 minutes less (p=0.042); the volume of blood loss, on average, is 550 ml less (p=0.000); the duration of the postoperative fasting phase is 2 days shorter (p=0.034); the duration of inpatient treatment is less than 8 days (p=0.021). The incidence of esophageal-gastric anastomosis failure is more often in the OE group, but the result is statistically insignificant (χ2=1.89; p=0.075). The frequency of pulmonary complications and cardiovascular complications was significantly lower in the LTSE group (p<0.05). The difference in the 30-day mortality rate between the OE and LTSE groups turned out to be statistically insignificant (χ2=2.56; p=0.0253).

Conclusion. The obvious advantages of Ivor Lewis type laparothoracoscopic esophagectomy are clarity of visualization, good hemostasis control, convenient mobilization of the stomach and esophagus, adequate lymph dissection, low access injuries, less need for opioid analgesics for post- operative pain relief, early mobilization of patients. This creates the conditions for reducing the period of inpatient treatment and the earlier initiation of adjuvant chemotherapy. All these factors, no doubt, can determine not only the best immediate, but also the long-term results of surgical treatment of esophageal cancer.

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