Application value of modified self-traction Overlap method in intrathoracic esophagogastrostomy of Ivor Lewis surgery

Objective To explore the application value of modified self-traction Overlap method in intrathoracic esophagogastrostomy of Ivor Lewis surgery. Methods The retrospective and descriptive study was conducted. The clinical data of 12 patients with lower esophageal carcinoma who underwent Ivor Lewis surgery in the Zhongshan Hospital of Fudan University from January to May 2018 were collected. There were 9 males and 3 females, aged from 50 to 73 years, with a median age of 61 years. Modified self-traction Overlap method was used for intrathoracic esophagogastrostomy during the surgery. The esophagus was pulled down with the ligature as traction and rotated clockwise by 45 degrees to perform side-to-side esophagogastric anastomosis. The common opening was closed by a laparoscopic linear cutting suturing device to form an esophagogastric Overlap triangle anastomosis, and finally the esophagus was disconnected. Observation indicators: (1) intraoperative and postoperative situations; (2) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect survival situation and tumor recurrence and metastasis up to January 2019. Measurement data were described as M (range). Results (1) Intraoperative and postoperative situations: all the 12 patients underwent successful Ivor Lewis surgery, without conversion to open surgery. The operation time, time of tubular gastroesophageal anastomosis, volume of intraoperative blood loss, time to initial anal exsufflation and time for initial fluid diet intake were 145 minutes (range, 125-189 minutes), 20 minutes (range, 16-35 minutes), 98 mL (range, 78-135 mL), 4 days (range, 3-5 days), 6 days (range, 5-7 days), respectively. All the patients had no complication. Patients underwent upper gastrointestinal iodine hydrography at 5 days after surgery, confirming no anastomotic leakage or stenosis. Patients recovered well and were discharged postoperatively. The duration of postoperative hospital stay was 8 days (range, 7-11 days). (2) Follow-up situations: 12 patients were followed up for 8.0-12.0 months, with a median time of 10.6 months. Patients survived well, with no tumor recurrence or metastasis. Conclusion Modified self-traction Overlap method in thoracic esophagogastrostomy of Ivor Lewis surgery is safe and feasible for lower esophageal carcinoma, with easy operating Key words: Esophageal neoplasms; Radical resection; Esophagogastrostomy; Thoracoscopy; Laparoscopy