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Side-overlap esophagogastric tube (SO-EG) reconstruction after minimally invasive Ivor Lewis esophagectomy or laparoscopic proximal gastrectomy for cancer of the esophagogastric junction

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Abstract

Purpose

Both laparoscopic proximal gastrectomy with lower esophagectomy (extended LPG) and minimally invasive Ivor Lewis esophagectomy (MIILE) are acceptable treatments for adenocarcinoma of the esophagogastric junction (AEG), but the optimal reconstruction technique for mediastinal esophagogastrostomy (one that provides adequate reflux prevention) has not been established. We devised a novel side-overlap esophagogastric-tube (SO-EG) reconstruction.

Methods

We performed a retrospective review of patient records after LPG or MIILE. In each patient, we created a 3-cm wide gastric tube, overlapping the esophagus by 5 cm. A linear stapler was inserted into the left side of the esophageal stump and the anterior gastric wall along the greater curvature. The entry hole was closed to make a slit-like anastomosis, and the right side of the esophageal wall was fixed to the anterior gastric wall.

Results

Ten consecutive patients underwent this procedure between June 2020 and July 2021. Five patients had Siewert type II AEG: 4 with lower thoracic esophageal cancer and 1 with benign lower esophageal stenosis. A total of 3 patients underwent extended LPG, and 7 underwent MIILE. The median operative time was 352 min (range, 221–556 min). The postoperative course was uneventful in 9 patients; a single patient developed pneumonia. Seven patients underwent follow-up endoscopy at 6 months. One patient with anastomotic stenosis and 2 with mild reflux esophagitis were treated conservatively.

Conclusion

Our novel SO-EG reconstruction is simple and feasible, with acceptable results for preventing reflux esophagitis. This technique can be performed with either extended LPG or MIILE.

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Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon request.

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Authors and Affiliations

  1. Department of Surgery, Japanese Red Cross Osaka Hospital, 5-30 Fudegasaki-cho, Osaka, Tennoji Ward, 543-8555, Japan

    Hisahiro Hosogi, Masazumi Sakaguchi, Daisuke Yagi, Ryohei Onishi, Yasuhiro Hashimoto, Yoshiharu Sakai & Seiichiro Kanaya

Authors
  1. Hisahiro Hosogi
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  2. Masazumi Sakaguchi
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  3. Daisuke Yagi
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  4. Ryohei Onishi
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  7. Seiichiro Kanaya
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Contributions

Study conception and design: HH and SK. Acquisition of data: HH and MS. Analysis and interpretation of data: HH and SK. Drafting of manuscript: HH. Critical revision of manuscript: DY, RO, YH, MS, YS, and SK.

Corresponding author

Correspondence to Hisahiro Hosogi.

Ethics declarations

Ethics approval

This study was conducted in accordance with the tenets of the Declaration of Helsinki and approved by the ethics committee of Japanese Red Cross Osaka Hospital (IRB J-0264).

Consent to participate

The requirement to obtain individual patient consent was waived by the ethics committee of Japanese Red Cross Osaka Hospital, given the retrospective nature of the case series.

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All authors have provided consent for the article to be published in the Langenbeck’s Archives of Surgery.

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The authors declare no competing interests.

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Supplementary Information

Fig. 1.

Trocar position in a) extended LPG and b) MIILE. The third, fifth, seventh, and ninth intercostal spaces are noted. The number in a circle shows the size of the trocar (mm). SA, scapular angle line; PA, posterior axillary line; MA, middle axillary line (DOCX 163 kb)

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Hosogi, H., Sakaguchi, M., Yagi, D. et al. Side-overlap esophagogastric tube (SO-EG) reconstruction after minimally invasive Ivor Lewis esophagectomy or laparoscopic proximal gastrectomy for cancer of the esophagogastric junction. Langenbecks Arch Surg 407, 861–869 (2022). https://doi.org/10.1007/s00423-021-02377-5

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  • DOI: https://doi.org/10.1007/s00423-021-02377-5

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