TY - JOUR
T1 - Technique of open and minimally invasive intrathoracic reconstruction following esophagectomy-an expert consensus based on a modified Delphi process
AU - Bartella, Isabel
AU - Fransen, Laura F. C.
AU - Gutschow, Christian A.
AU - Bruns, Christiane J.
AU - van Berge Henegouwen, Mark L.
AU - Chaudry, M. Asif
AU - Cheong, Edward
AU - Cuesta, Miguel A.
AU - van Daele, Elke
AU - Gisbertz, Suzanne S.
AU - van Hillegersberg, Richard
AU - Hölscher, Arnulf
AU - Mercer, Stuart
AU - Moorthy, Krishna
AU - Nafteux, Philippe
AU - Nilsson, Magnus
AU - Pattyn, Piet
AU - Piessen, Guillaume
AU - Räsanen, Jari
AU - Rosman, Camiel
AU - Ruurda, Jelle P.
AU - Schneider, Paul M.
AU - Sgromo, Bruno
AU - Nieuwenhuijzen, Grard A.
AU - Luyer, Misha D. P.
AU - Schröder, Wolfgang
N1 - Publisher Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
PY - 2021/11/11
Y1 - 2021/11/11
N2 - 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 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.
AB - 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 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.
KW - Delphi methodology
KW - esophagectomy
KW - intrathoracic reconstruction
KW - minimally invasive technique
UR - http://www.scopus.com/inward/record.url?scp=85114626822&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/dote/doaa127
DO - https://doi.org/10.1093/dote/doaa127
M3 - Article
C2 - 33846718
SN - 1120-8694
VL - 34
JO - Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
JF - Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
IS - 11
M1 - doaa127
ER -