[Laparothoracoscopic Ivor Lewis esophagectomy with esophageal-gastric intrapleural anastomosis]

To describe the methodology of laparothoracoscopic Ivor Lewis esophagectomy in surgical treatment of esophageal cancer and compare early outcomes of this procedure with conventional Ivor Lewis surgery.

There were 30 laparothoracoscopic Ivor Lewis esophagectomies followed by non-hardware esophageal-gastric intrapleural anastomosis for esophageal cancer. All procedures have been performed for the period 2016-2019 at the Moscow Regional Research and Clinical Institute (suturing of anastomosis was based on the method of professor A.S. Allakhverdyan).

Laparothoracoscopic esophagectomy is characterized by higher surgery time by 136.57 min (p=0.012), less duration of anesthesia and mechanical ventilation by 77.5 min (p=0.042), postoperative ICU-stay by 2.25 hours (p=0.021), blood loss by 550 ml (p=0,000), duration of postoperative fasting by 2 days (p=0.034), hospital-stay by 8 days (p=0.021) compared to open esophagectomy. There were no significant between-group differences in the number of resected lymph nodes (p=0.142). Incidence of esophageal-gastric anastomosis failure is insignificantly higher in the OE group (χ²=1.89; p=0.075). Incidence of pulmonary complications (pneumonia, chylothorax, paresis of the vocal cords, pleural empyema) is less in the LTSE group (p<0.05). Cardiovascular morbidity is significantly lower in the LTSE group (p<0.05). A 30-day mortality rate was similar in both groups (χ²=2.56; p=0.0253).

Early results of laparothoracoscopic Ivor Lewis esophagectomy are superior to the results of conventional Ivor Lewis surgery in surgical treatment of esophageal cancer.