Isabel Bartella1, Laura F C Fransen2, Christian A Gutschow3, Christiane J Bruns1, Mark L van Berge Henegouwen4, M Asif Chaudry5, Edward Cheong6, Miguel A Cuesta4, Elke Van Daele7, Suzanne S Gisbertz4, Richard van Hillegersberg8, Arnulf Hölscher9, Stuart Mercer10, Krishna Moorthy11, Philippe Nafteux12, Magnus Nilsson13, Piet Pattyn7, Guillaume Piessen14, Jari Räsanen15, Camiel Rosman16, Jelle P Ruurda8, Paul M Schneider3, Bruno Sgromo17, Grard A Nieuwenhuijzen2, Misha D P Luyer2, Wolfgang Schröder1. 1. Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Cologne, Germany. 2. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands. 3. Department of General and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland. 4. Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands. 5. Department of Surgery, The Royal Marsden Hospital, London, UK. 6. Department of Upper GI Surgery, Norfolk and Norwich University Hospital, Norwich, UK. 7. Department of GI Surgery, University Hospital Ghent, Ghent, Belgium. 8. Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands. 9. Center for Esophageal and Gastric Cancer Surgery, Markushospital Frankfurt, Frankfurt am Main, Germany. 10. Department of Upper GI Surgery, Queen Alexandra Hospital, Portsmouth, UK. 11. Department of Surgery and Cancer, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK. 12. Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium. 13. Department of Upper Abdominal Disease, Karolinska University Hospital, Stockholm, Sweden. 14. Department of Digestive and Oncological Surgery, Lille University Hospital, Lille, France. 15. Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Helsinki, Finland. 16. Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands. 17. Department of Upper GI Surgery, Oxford University Hospitals, Oxford, UK.
Abstract
BACKGROUND: In recent years, minimally invasive Ivor Lewis (IL) esophagectomy with high intrathoracic anastomosis has emerged as surgical standard of care for esophageal cancer in expert centers. Alongside this process, many divergent technical aspects of this procedure have been devised in different centers. This study aims at achieving international consensus on the surgical steps of IL reconstruction using Delphi methodology. METHODS: The expert panel consisted of specialized esophageal surgeons from 8 European countries. During a two-round Delphi process, a detailed analysis and consensus on key steps of intrathoracic gastric tube reconstruction (IL esophagectomy) was performed. RESULTS: Response rates in Delphi rounds 1 and 2 were 100% (22 of 22 experts) and 83.3% (20 of 24 experts), respectively. Three essential technical areas of intrathoracic gastric tube reconstruction were identified: first, vascularization of the gastric conduit, second, gastric mobilization, tube formation and pull-up, and third, anastomotic technique. In addition, 3 main techniques for minimally invasive intrathoracic anastomosis are currently practiced: (i) end-to-side circular stapled, (ii) end-to-side double stapling, and (iii) side-to-side linear stapled technique. The step-by-step procedural analysis unveiled common approaches but also different expert practice. CONCLUSION: This precise technical description may serve as a clinical guideline for intrathoracic reconstruction after esophagectomy. In addition, the results may aid to harmonize the technical evolution of this complex surgical procedure and thereby facilitate surgical training.
BACKGROUND: In recent years, minimally invasive Ivor Lewis (IL) esophagectomy with high intrathoracic anastomosis has emerged as surgical standard of care for esophageal cancer in expert centers. Alongside this process, many divergent technical aspects of this procedure have been devised in different centers. This study aims at achieving international consensus on the surgical steps of IL reconstruction using Delphi methodology. METHODS: The expert panel consisted of specialized esophageal surgeons from 8 European countries. During a two-round Delphi process, a detailed analysis and consensus on key steps of intrathoracic gastric tube reconstruction (IL esophagectomy) was performed. RESULTS: Response rates in Delphi rounds 1 and 2 were 100% (22 of 22 experts) and 83.3% (20 of 24 experts), respectively. Three essential technical areas of intrathoracic gastric tube reconstruction were identified: first, vascularization of the gastric conduit, second, gastric mobilization, tube formation and pull-up, and third, anastomotic technique. In addition, 3 main techniques for minimally invasive intrathoracic anastomosis are currently practiced: (i) end-to-side circular stapled, (ii) end-to-side double stapling, and (iii) side-to-side linear stapled technique. The step-by-step procedural analysis unveiled common approaches but also different expert practice. CONCLUSION: This precise technical description may serve as a clinical guideline for intrathoracic reconstruction after esophagectomy. In addition, the results may aid to harmonize the technical evolution of this complex surgical procedure and thereby facilitate surgical training.
Authors: Fiorenzo V Angehrn; Kerstin J Neuschütz; Daniel C Steinemann; Martin Bolli; Lana Fourie; Pauline Becker; Markus von Flüe Journal: Surg Endosc Date: 2022-07-19 Impact factor: 3.453
Authors: A Peri; N Furbetta; J Viganò; L Pugliese; G Di Franco; F S Latteri; N Mineo; F C Bruno; V Gallo; L Morelli; A Pietrabissa Journal: Surg Endosc Date: 2021-09-09 Impact factor: 4.584