To explore the clinical applications and early results of modified reverse-puncture anastomosis technique for total endoscopic Ivor Lewis esophagectomy.

A retrospective analysis was made of 48 patients with medial and lower esophageal cancer who underwent modified reverse-puncture anastomotic technique between Feb.2014 and Jun. 2018.The operation was divided into three steps: The first step was laparoscopic mobilization of the stomach and the abdominal segment of the esophagus and dissection of the abdominal lymph node.Thoracoscopic mobilization of thoracic segment of esophagus and tumor and dissection of the thoracic lymph node was following.Last, intrathoracic anastomosis was finished by modified reverse-puncture anastomosis technique.

All 48 patients underwent anastomosis under the endoscope. The operation was smooth. There were no thoracoabdominal auxiliary incision and transit thoracotomy performed. The mean overall operation time was (253.4±57.2) min, the mean thoracoscopic operation time was (175.6±64.5) minutes.The mean estimated blood loss was (107.3±87.4) ml. The mean number of nodes harvested from every patient was (15.2±2.5). Severe pulmonary infection and anastomotic fistula was observed in one patient with obesity, diabetes and hypertension (1/48, 2.1%), which was cured with conservative treatment.Anastomotic stenosis was observed in another three patients(3/48, 6.3%). The duration of liquid feeding was (7.2±1.3) days and the mean length of hospital stay was 10-16 days(range, 11 days; except one case with anastomotic leak).

The good short-term outcomes that were achieved suggested that the use of modified reverse-puncture anastomotic technique is safe and feasible for total endoscopic Ivor Lewis esophagectomy.