Prophylactic application of modified vacuum-assisted closure therapy in Ivor Lewis esophagectomy: Preliminary results

doi:10.4240/wjgs.124340

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Publication Name

World Journal of Gastrointestinal Surgery

ISSN

1948-9366

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Nov 27, 2026; 18(11): 124340
Published online Nov 27, 2026. doi: 10.4240/wjgs.124340

Prophylactic application of modified vacuum-assisted closure therapy in Ivor Lewis esophagectomy: Preliminary results

Kaan Ciciboga, Tevfik Kıvılcım Uprak, Nezih Onur Ermerak

Kaan Ciciboga, Tevfik Kıvılcım Uprak, Department of General Surgery, Marmara University, Istanbul 34890, Türkiye

Nezih Onur Ermerak, Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul 34890, Türkiye

Co-first authors: Kaan Ciciboga and Tevfik Kıvılcım Uprak.

Author contributions: Ciciboga K conceived the study, collected and analyzed the data, participated in the surgical procedures and postoperative patient follow-up, performed the statistical analyses, and drafted the manuscript; Uprak TK designed and supervised the study, performed the surgical procedures, contributed to data interpretation, and critically revised the manuscript for important intellectual content; Ermerak NO participated in the surgical procedures, contributed to perioperative patient management and data interpretation, and critically revised the manuscript; All authors read and approved the final version of the manuscript. Ciciboga K and Uprak TK contributed equally to this manuscript as co-first authors.

AI contribution statement: Portions of this manuscript were edited using ChatGPT (OpenAI) solely to assist with English language refinement, grammar, and stylistic improvement. All AI-assisted outputs were carefully reviewed, verified, and revised by the authors. AI was not used to generate original scientific data, perform scientific analyses, interpret results, or draw scientific conclusions. The authors take full responsibility for the accuracy, integrity, and scientific content of the manuscript.

Institutional review board statement: This study was approved by the Institutional Ethics Committee of Marmara University Faculty of Medicine, Istanbul, Türkiye (Approval No. 09.2024.610).

Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available because they contain information that could compromise patient privacy but are available from the corresponding author upon reasonable request (mdkaanciciboga@gmail.com).

Corresponding author: Nezih Onur Ermerak, MD, Department of Thoracic Surgery, Marmara University School of Medicine, Fevzi Çakmak Mahallesi Muhsin, Yazıcıoğlu Caddesi No. 10, Istanbul 34890, Türkiye. onur.ermerak@marmara.edu.tr

Received: June 12, 2026
Revised: July 15, 2026
Accepted: September 4, 2026
Published online: November 27, 2026
Processing time: 153 Days and 14.6 Hours

Abstract

BACKGROUND

Ivor Lewis esophagectomy is the standard surgical approach for middle and distal esophageal cancer. Despite advances in minimally invasive techniques and perioperative care, anastomotic leakage (AL) remains a major cause of postoperative morbidity and mortality. Although prophylactic endoluminal vacuum therapy has shown promise, its clinical use is limited by procedural complexity and cost.

AIM

To evaluate the feasibility, safety, and preliminary clinical outcomes of a modified, endoscopy-independent prophylactic vacuum-assisted closure system (ModVAC) in patients undergoing Ivor Lewis esophagectomy.

METHODS

This retrospective single-center study included 31 patients who underwent Ivor Lewis esophagectomy from July 2019 to June 2024. Sixteen patients received prophylactic ModVAC therapy, while fifteen earlier patients served as historical controls. The primary outcome was AL.

RESULTS

Baseline characteristics were comparable between groups. AL occurred in 25% vs 40% of patients (P = 0.37), with all ModVAC leaks managed non-operatively. Hospital stay, morbidity, and mortality were similar. Protocol completion was 81.25% with minimal device-related complications.

CONCLUSION

Prophylactic ModVAC is a feasible and safe adjunct following Ivor Lewis esophagectomy. Although leak reduction was not statistically significant, the favorable management of leaks suggests potential clinical benefit. Larger prospective randomized studies are warranted.

Keywords: Esophagectomy; Anastomotic leak; Esophageal neoplasms; Endoscopic vacuum therapy; Ivor Iewis esophagectomy

Core Tip: Anastomotic leakage remains one of the most serious complications after Ivor Lewis esophagectomy. This study presents the first clinical experience with a modified, endoscopy-independent prophylactic vacuum-assisted closure system (ModVAC) that can be placed intraoperatively using standard surgical materials. ModVAC was feasible, safe, and achieved a high protocol completion rate with minimal device-related complications. Although the reduction in anastomotic leakage did not reach statistical significance in this preliminary cohort, all leaks in the ModVAC group were managed non-operatively, supporting further evaluation of this simple, low-cost prophylactic approach in larger prospective studies.