Use of the Stomach in Esophageal Reconstructive Surgery in Era of Minimally Invasive Approach

Abstract

Esophagectomy is standard indication for surgical treatment of resectable esophageal cancer, but it can also be performed for the management of benign conditions. Esophagectomy is followed by esophageal reconstruction using other parts of the digestive tract and is associated with increased postoperative morbidity and mortality. Gastric interposition with intrathoracic or cervical esophago-gastric anastomosis is currently the preferred technique for reconstruction after esophagectomy. The incidence of esophagectomy performed by the minimal invasive approach has increased in recent years due to the advanced technology of endoscopic surgery and image enhancement that provides a better estimate of anatomical plans, facilitates access to narrow spaces and more precise dissection with less tissue trauma. Randomized clinical trials have found a significant reduction in postoperative respiratory complications, decreased hospital stay and equivalent oncological results to open esophagectomy. We present the operative technique of minimally invasive esophagectomy performed in our clinic by three-stage modified McKeown approach thoracoscopic, laparoscopic and cervical with esophageal reconstruction with stomach.

Utility of single-port laparoscopic retrograde gastric mobilization during McKeown esophagectomy for esophageal cancer: a 2-year experience with 120 cases in a single institution

“…Second, we optimized the surgical procedure. Conventional laparoscopic gastric mobilization starts from the greater curvature ( 19 , 20 ). The space is limited by the upper diaphragm.…”

Comparison of a modified one‑piece mechanical and double‑layer hand‑sewn anastomosis in McKeown esophagogastrectomy: A single‑institute retrospective study

“…However, accounting for nearly 95% of all cases in China, most esophageal squamous cell carcinoma (ESCC) locates in the intrathoracic portion and surgical resection remains the preferred modality of radical treatment, especially for the early-or mid-staged lesions (5). After esophagectomy, reconstruction using a gastric conduit is the most common procedure (6), although various other anastomotic techniques have been demonstrated (7)(8)(9)(10). However, reconstruction surgery following resection of the esophagus is frequently associated with occurrence of anastomotic leakage.…”