[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 ( 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).

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