Robotic Side-to-Side and End-to-Side Stapled Esophagogastric Anastomosis of Ivor Lewis Esophagectomy for Cancer

Background Both linear-stapled side-to-side esophagogastric anastomosis (LSEA) and circular-stapled end-to-side esophagogastric anastomosis (CEEA) are frequently used following esophagectomy. The aims of the present study were to review our experience of robotic intrathoracic alimentary tract reconstruction and to compare the short-term surgical outcomes of LSEA and CEEA in robotic Ivor Lewis esophagectomy. Methods A prospectively collected dataset from 79 consecutive patients who underwent robot-assisted Ivor Lewis esophagectomy from February 2016 to December 2018 was retrospectively analyzed. Two groups (LSEA and CEEA) were classified according to the anastomotic mode. Demographic data, intraoperative characteristics and short-term surgical outcomes were compared between the two groups. Results Two patients were converted to laparotomy. The remaining 77 patients (68 males and 9 females, mean age of 61.7 years) were successfully treated with completely robotic Ivor Lewis esophagectomy. According to the anastomotic procedure performed, 35 patients were categorized into the LSEA group and 42 patients were categorized into the CEEA group. The mean anastomotic time in the LSEA group was longer than that in the CEEA group (63.0 +/- 9.0 vs. 44.2 +/- 8.5 min, p<0.001). No significant difference was detected in anastomotic complications, including leakage (8.6% with LSEA and 4.8% with CEEA, p=0.83) and postoperative dysphagia (5.7% with LSEA and 16.7% with CEEA, p=0.26). No statistical difference was observed for the other surgical outcomes. There was no incidence of in-hospital mortality and 30-day mortality in both groups. Conclusions In robotic Ivor Lewis esophagectomy, both LSEA and CEEA were feasible and safe to be performed and surgeons can select either LSEA or CEEA based on their own technical expertise.