title: Anastomosis in minimally invasive Ivor Lewis esophagectomy via two ports provides equivalent perioperative outcomes to open.
abstract: OBJECTIVE
  Minimally invasive esophagectomy (MIE) is becoming a selective treatment of esophageal cancer; however, it's a complex and technically demanding surgical operation. MIE can be performed in high volume centers in a variety of ways using different techniques. Transthoracic staplers have traditionally been used in open transthoracic Ivor Lewis Esophagectomy (ILE) with good success. An investigation of the safety and utility of transthoracic stapler via two ports on thorax for esophageal anastomosis in minimally invasive ILE is reviewed.
  
  
  METHODS
  Patients of esophageal cancer were selected between November 2012 and July 2014. All the patients received minimally invasive (MIE) or open transthoracic ILE. Transthoracic stapler for MIE anastomosis was performed through the major port located at subaxillary region. Patients' demographics, indications for esophagectomy, perioperative treatments, intraoperative data, postoperative complications, hospital length of stay, 7 and in-hospital mortality were evaluated.
  
  
  RESULTS
  Totally, 63 consecutive patients underwent MIE or ILE. All the patients were Han with a mean age of 60 years (52-74). The indication of surgery is esophageal cancer, and squamous cell carcinoma was defined by pathologist before operation. None of the patients had neoadjuvant chemotherapy or radiation. All the MIE patients were no conversions to open thoracotomy or laparotomy. Mean operative time was 4.5 h. One patient (3.03%) suffered postoperative pneumonia, no leak from the gastric conduit staple line or esophageal anastomoses, no postoperative complication required surgical intervention was observed. The median hospital length of stay was 13 days (range 7-18). There were no in-hospital mortalities.
  
  
  CONCLUSIONS
  In our study, transthoracic stapler through the major port at subaxillary seems technically feasible and safe for minimally invasive ILE with comparable morbidity and oncologic data to open.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: W
authors.initials: W
authors.lastname: Jiao
authors.forename: J
authors.initials: J
authors.lastname: Zhao
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.forename: Y
authors.initials: Y
authors.lastname: Luo
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009367:Neoplasm Staging; D019990:Perioperative Care; D011183:Postoperative Complications; D011379:Prognosis