A reproducible anastomosis in robotic Ivor-Lewis esophagectomy: a simple fix for a persistent problem in a zero-leak...

Robotic Ivor-Lewis esophagectomy is increasingly adopted due to its minimally invasive approach and favorable outcomes. Anastomotic leak remains the most serious complication after esophagectomy, with reported rates of 5-18%. We describe a reinforced, stapled, single-layer, thoracic anastomosis which has resulted in no leaks in 50 consecutive patients.

We performed a retrospective review of consecutive patients who underwent robotic Ivor-Lewis esophagectomy by a two-surgeon team.

From January 2022 to February 2026, 50 patients were included with a median age of 70 years. Indications for surgery were malignancy in 47 patients, most commonly adenocarcinoma (85.1%) and benign disease in 3 patients. Median operative time was 237 min, median actual blood loss was 35 mL and median lymph node yield was 20. R0 resection was achieved in all 47 malignant cases. Complete pathologic response (pCR) was observed in 13 out of 38 patients that received neoadjuvant therapy (34.2%). There were no conversions, and median LOS was 4 days. No anastomotic leaks were detected clinically, radiographically, or biochemically and there was no 30- or 90-day mortality. At a median follow-up of 26.8 months, 1- and 2-year overall survival rates were 88.2 and 84.6%, respectively.

This technique, when properly executed, is reproducible, safe, and can afford R0 resection and thorough thoracic lymph node dissection, with promising results. Prospective, multicenter studies are needed to compare this approach to alternative anastomotic techniques.