Technique of open and minimally invasive intrathoracic reconstruction following esophagectomy-an expert consensus based on a modified Delphi process
Bartella, Isabel; Fransen, Laura F C; Gutschow, Christian A; Bruns, Christiane J; van Berge Henegouwen, Mark L; Chaudry, M Asif; Cheong, Edward; Cuesta, Miguel A; Van Daele, Elke; Gisbertz, Suzanne S; van Hillegersberg, Richard; Hölscher, Arnulf; Mercer, Stuart; Moorthy, Krishna; Nafteux, Philippe; Nilsson, Magnus; Pattyn, Piet; Piessen, Guillaume; Räsanen, Jari; Rosman, Camiel; Ruurda, Jelle P; Schneider, Paul M; Sgromo, Bruno; Nieuwenhuijzen, Grard A; Luyer, Misha D P; Schröder, Wolfgang
(2021) Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus, volume 34, issue 11, pp. 1 - 8
(Article)
Abstract
BACKGROUND: In recent years, minimally invasive Ivor Lewis (IL) esophagectomy with high intrathoracic anastomosis has emerged as surgical standard of care for esophageal cancer in expert centers. Alongside this process, many divergent technical aspects of this procedure have been devised in different centers. This study aims at achieving international consensus
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on the surgical steps of IL reconstruction using Delphi methodology. METHODS: The expert panel consisted of specialized esophageal surgeons from 8 European countries. During a two-round Delphi process, a detailed analysis and consensus on key steps of intrathoracic gastric tube reconstruction (IL esophagectomy) was performed. RESULTS: Response rates in Delphi rounds 1 and 2 were 100% (22 of 22 experts) and 83.3% (20 of 24 experts), respectively. Three essential technical areas of intrathoracic gastric tube reconstruction were identified: first, vascularization of the gastric conduit, second, gastric mobilization, tube formation and pull-up, and third, anastomotic technique. In addition, 3 main techniques for minimally invasive intrathoracic anastomosis are currently practiced: (i) end-to-side circular stapled, (ii) end-to-side double stapling, and (iii) side-to-side linear stapled technique. The step-by-step procedural analysis unveiled common approaches but also different expert practice. CONCLUSION: This precise technical description may serve as a clinical guideline for intrathoracic reconstruction after esophagectomy. In addition, the results may aid to harmonize the technical evolution of this complex surgical procedure and thereby facilitate surgical training.
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Keywords: Delphi methodology, esophagectomy, intrathoracic reconstruction, minimally invasive technique, Gastroenterology
ISSN: 1120-8694
Publisher: Wiley-Blackwell
Note: Publisher Copyright: © 2021 Oxford University Press. All rights reserved.
(Peer reviewed)