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

Objective: 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.

Material And Methods: 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).

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

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