Side-overlap esophagogastric tube (SO-EG) reconstruction after minimally invasive Ivor Lewis esophagectomy or laparoscopic proximal gastrectomy for cancer of the esophagogastric ... View Full Text


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Article Info

DATE

2021-11-13

AUTHORS

Hisahiro Hosogi, Masazumi Sakaguchi, Daisuke Yagi, Ryohei Onishi, Yasuhiro Hashimoto, Yoshiharu Sakai, Seiichiro Kanaya

ABSTRACT

PurposeBoth laparoscopic proximal gastrectomy with lower esophagectomy (extended LPG) and minimally invasive Ivor Lewis esophagectomy (MIILE) are acceptable treatments for adenocarcinoma of the esophagogastric junction (AEG), but the optimal reconstruction technique for mediastinal esophagogastrostomy (one that provides adequate reflux prevention) has not been established. We devised a novel side-overlap esophagogastric-tube (SO-EG) reconstruction.MethodsWe performed a retrospective review of patient records after LPG or MIILE. In each patient, we created a 3-cm wide gastric tube, overlapping the esophagus by 5 cm. A linear stapler was inserted into the left side of the esophageal stump and the anterior gastric wall along the greater curvature. The entry hole was closed to make a slit-like anastomosis, and the right side of the esophageal wall was fixed to the anterior gastric wall.ResultsTen consecutive patients underwent this procedure between June 2020 and July 2021. Five patients had Siewert type II AEG: 4 with lower thoracic esophageal cancer and 1 with benign lower esophageal stenosis. A total of 3 patients underwent extended LPG, and 7 underwent MIILE. The median operative time was 352 min (range, 221–556 min). The postoperative course was uneventful in 9 patients; a single patient developed pneumonia. Seven patients underwent follow-up endoscopy at 6 months. One patient with anastomotic stenosis and 2 with mild reflux esophagitis were treated conservatively.ConclusionOur novel SO-EG reconstruction is simple and feasible, with acceptable results for preventing reflux esophagitis. This technique can be performed with either extended LPG or MIILE. More... »

PAGES

861-869

References to SciGraph publications

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  • 2011-04-12. Linear Stapled Esophagogastrostomy is more Effective than Hand-Sewn or Circular Stapler in Prevention of Anastomotic Stricture: a Comparative Clinical Study in JOURNAL OF GASTROINTESTINAL SURGERY
  • 2016-12-10. Side overlap esophagogastrostomy to prevent reflux after proximal gastrectomy in GASTRIC CANCER
  • 2018-05-14. Mesenteric excision for esophageal cancer surgery: based on the concept of mesotracheoesophagus in INTERNATIONAL CANCER CONFERENCE JOURNAL
  • 2017-06-27. Short-term outcomes after laparoscopic versus open transhiatal resection of Siewert type II adenocarcinoma of the esophagogastric junction in SURGICAL ENDOSCOPY
  • 2013-09-20. Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer in GASTRIC CANCER
  • 2017-01-27. Clinical Outcomes and Evaluation of Laparoscopic Proximal Gastrectomy with Double-Flap Technique for Early Gastric Cancer in the Upper Third of the Stomach in ANNALS OF SURGICAL ONCOLOGY
  • 2021-04-09. A long-term follow-up study of minimally invasive Ivor Lewis esophagectomy with linear stapled anastomosis in SURGICAL ENDOSCOPY
  • Identifiers

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    http://scigraph.springernature.com/pub.10.1007/s00423-021-02377-5

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    http://dx.doi.org/10.1007/s00423-021-02377-5

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/34775522


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    29 schema:description PurposeBoth laparoscopic proximal gastrectomy with lower esophagectomy (extended LPG) and minimally invasive Ivor Lewis esophagectomy (MIILE) are acceptable treatments for adenocarcinoma of the esophagogastric junction (AEG), but the optimal reconstruction technique for mediastinal esophagogastrostomy (one that provides adequate reflux prevention) has not been established. We devised a novel side-overlap esophagogastric-tube (SO-EG) reconstruction.MethodsWe performed a retrospective review of patient records after LPG or MIILE. In each patient, we created a 3-cm wide gastric tube, overlapping the esophagus by 5 cm. A linear stapler was inserted into the left side of the esophageal stump and the anterior gastric wall along the greater curvature. The entry hole was closed to make a slit-like anastomosis, and the right side of the esophageal wall was fixed to the anterior gastric wall.ResultsTen consecutive patients underwent this procedure between June 2020 and July 2021. Five patients had Siewert type II AEG: 4 with lower thoracic esophageal cancer and 1 with benign lower esophageal stenosis. A total of 3 patients underwent extended LPG, and 7 underwent MIILE. The median operative time was 352 min (range, 221–556 min). The postoperative course was uneventful in 9 patients; a single patient developed pneumonia. Seven patients underwent follow-up endoscopy at 6 months. One patient with anastomotic stenosis and 2 with mild reflux esophagitis were treated conservatively.ConclusionOur novel SO-EG reconstruction is simple and feasible, with acceptable results for preventing reflux esophagitis. This technique can be performed with either extended LPG or MIILE.
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    36 schema:keywords AEG
    37 Ivor Lewis esophagectomy
    38 LPG
    39 MIILE
    40 MethodsWe
    41 SO
    42 Siewert type II AEG
    43 acceptable results
    44 acceptable treatment
    45 adenocarcinoma
    46 anastomosis
    47 anastomotic stenosis
    48 anterior gastric wall
    49 cancer
    50 consecutive patients
    51 course
    52 curvature
    53 endoscopy
    54 entry hole
    55 esophageal cancer
    56 esophageal stenosis
    57 esophageal stump
    58 esophageal wall
    59 esophagectomy
    60 esophagitis
    61 esophagogastric junction
    62 esophagogastrostomy
    63 esophagus
    64 follow
    65 gastrectomy
    66 gastric tube
    67 gastric wall
    68 greater curvature
    69 holes
    70 invasive Ivor Lewis esophagectomy
    71 junction
    72 laparoscopic proximal gastrectomy
    73 left side
    74 linear stapler
    75 lower esophageal stenosis
    76 lower esophagectomy
    77 lower thoracic esophageal cancer
    78 median operative time
    79 mild reflux esophagitis
    80 min
    81 months
    82 operative time
    83 optimal reconstruction technique
    84 patient records
    85 patients
    86 pneumonia
    87 postoperative course
    88 procedure
    89 proximal gastrectomy
    90 reconstruction
    91 reconstruction technique
    92 records
    93 reflux esophagitis
    94 results
    95 retrospective review
    96 review
    97 right side
    98 side
    99 single patient
    100 stapler
    101 stenosis
    102 stump
    103 technique
    104 thoracic esophageal cancer
    105 time
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    108 tube
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