title: Techniques and short-term outcomes for total minimally invasive Ivor Lewis esophageal resection in distal esophageal and gastroesophageal junction cancers: pooled data from six European centers.
abstract: Esophagectomy for cancer can be performed in a two-stage procedure with an intrathoracic anastomosis: the Ivor Lewis esophagectomy. A growing incidence of distal and gastroesophageal junction adenocarcinomas and increasing use of minimally invasive techniques have prompted interest in this procedure. The aim of this study was to assess short-term results of minimally invasive Ivor Lewis esophagectomy (MIE-IL).
  
  
  
  A retrospective cohort study was performed from June 2007 until September 2014, including patients that underwent MIE-IL for distal esophageal and gastroesophageal junction cancer in six different hospitals in the Netherlands and Spain. Data were collected with regard to operative techniques, pathology and postoperative complications.
  
  
  
  In total, 282 patients underwent MIE-IL, of which 90.2 % received neoadjuvant therapy. Anastomotic leakage was observed in 43 patients (15.2 %), of whom 13 patients (4.6 %) had empyema, necessitating thoracotomy for decortication. With an aggressive treatment of complications, the 30-day and in-hospital mortality rate was 2.1 %. An R0-resection was obtained in 92.5 % of the patients. After neoadjuvant therapy, 20.1 % of patients had a complete response.
  
  
  
  Minimally invasive Ivor Lewis esophagectomy for distal esophageal and gastroesophageal junction adenocarcinomas is an upcoming approach for reducing morbidity caused by laparotomy and thoracotomy. Anastomotic leakage rate is still high possibly due to technical diversity of anastomotic techniques, and a high percentage of patients treated by neoadjuvant chemoradiotherapy. An aggressive approach to complications leads to a low mortality of 2.1 %. Further improvement and standardization in the anastomotic technique are needed in order to perform a safe intrathoracic anastomosis.
authors.affiliation: Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands. je.straatman@vumc.nl.|Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. je.straatman@vumc.nl.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Straatman
authors.affiliation: Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Nicole
authors.initials: N
authors.lastname: van der Wielen
authors.affiliation: Department of Gastrointestinal Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Grard A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
authors.affiliation: Department of Gastrointestinal Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: Camiel
authors.initials: C
authors.lastname: Rosman
authors.affiliation: Department of Gastrointestinal Surgery, Hospital Universitari Dr. Josep Trueta, Girona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Roig
authors.affiliation: Department of Gastrointestinal Surgery, Reinier de Graaf Hospital, Delft, The Netherlands.
authors.forename: Joris J G
authors.initials: JJ
authors.lastname: Scheepers
authors.affiliation: Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Cuesta
authors.affiliation: Department of Gastrointestinal Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Misha D P
authors.initials: MD
authors.lastname: Luyer
authors.affiliation: Department of Gastrointestinal Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Mark I
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.affiliation: Department of Gastrointestinal Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: Frans
authors.initials: F
authors.lastname: van Workum
authors.affiliation: Department of Gastrointestinal Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Suzanne S
authors.initials: SS
authors.lastname: Gisbertz
authors.affiliation: Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Donald L
authors.initials: DL
authors.lastname: van der Peet
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000628:therapy*; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000209:etiology; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000401:mortality / Q000628:therapy*; D016629:Esophagectomy / Q000379:methods*; D004943:Esophagogastric Junction / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009426:Netherlands; D011183:Postoperative Complications; D012189:Retrospective Studies; D013030:Spain; D013906:Thoracoscopy
keywords: Esophageal cancer; Esophagectomy; Intrathoracic anastomosis; Ivor Lewis; Minimally invasive