title: Thoracoscopic side-to-side esophagogastrostomy by use of linear stapler-a simplified technique facilitating a minimally invasive Ivor-Lewis operation.
abstract: OBJECTIVE
  Minimally invasive esophagectomy (MIE) has been met with increased interest for the surgical treatment of esophageal cancer. One critical obstacle for the implementation of MIE has been the intrathoracic anastomosis. In this study, we describe a technique of thoracoscopic intrathoracic anastomosis using a linear stapler in prone position and present the short-term outcomes of this procedure.
  
  
  METHODS
  This prospective pilot study included 46 consecutive patients with a cancer either of the gastroesophageal junction (GEJ) or the distal esophagus who underwent either total MIE or thoracoscopic-assisted esophagectomy followed by intrathoracic stapled side-to-side anastomosis. The short-term outcomes including postoperative complications were recorded and analyzed.
  
  
  RESULTS
  This pilot study included 41 males (89 %) and 5 females (11 %) with a mean age of 65.7 years. The majority had adenocarcinoma (93 %). Before surgery, 4 patients (8.7 %) had an incomplete endoscopic submucosal resection, 5 patients (11 %) received chemotherapy alone, and 33 patients (71 %) had chemoradiotherapy. Mean operation time was 408 minutes. Postoperative complications classified as Clavien-Dindo Grade IIIa or more severe occurred in 7 patients (15 %), of whom 4 patients (8.7 %) developed anastomotic leakages without any need for intensive care. Another 2 patients (4.3 %) required intensive care due to aspiration pneumonia and acute renal failure. No in-hospital mortality was registered. Only one patient (2.2 %) with anastomotic leakage developed postoperative anastomotic stenosis requiring balloon dilatation.
  
  
  CONCLUSIONS
  The intrathoracic stapled side-to-side anastomosis technique seems to be feasible, safe, and easy to perform, associated with a limited postsurgical complication rate and a good functional outcome.
authors.affiliation: Center for Digestive Diseases, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Irino
authors.affiliation: Center for Digestive Diseases, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden.|Division of Surgery, CLINTEC, Karolinska Institute, Huddinge, 141 86, Stockholm, Sweden.
authors.forename: Jon A
authors.initials: JA
authors.lastname: Tsai
authors.affiliation: Department of Clinical Nutrition and Dietetics, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden.
authors.forename: Jessica
authors.initials: J
authors.lastname: Ericson
authors.affiliation: Center for Digestive Diseases, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden.|Division of Surgery, CLINTEC, Karolinska Institute, Huddinge, 141 86, Stockholm, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Nilsson
authors.affiliation: Center for Digestive Diseases, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden.|Division of Surgery, CLINTEC, Karolinska Institute, Huddinge, 141 86, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Lundell
authors.affiliation: Center for Digestive Diseases, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden. ioannis.rouvelas@ki.se.|Division of Surgery, CLINTEC, Karolinska Institute, Huddinge, 141 86, Stockholm, Sweden. ioannis.rouvelas@ki.se.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Rouvelas
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010865:Pilot Projects; D011446:Prospective Studies; D013270:Stomach / Q000601:surgery; D017792:Surgical Stapling / Q000379:methods*; D013906:Thoracoscopy
keywords: Intrathoracic anastomosis; Minimally invasive esophagectomy; Postoperative complication; Side-to-side stapled anastomosis