Original Article
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2014; 6(12): 235-240
Published online Dec 27, 2014. doi: 10.4240/wjgs.v6.i12.235
Intrathoracic esophagojejunostomy using OrVil™ for gastric adenocarcinoma involving the esophagus
Kazuhito Yajima, Tatsuo Kanda, Shin-ichi Kosugi, Yosuke Kano, Takashi Ishikawa, Hiroshi Ichikawa, Takaaki Hanyu, Toshifumi Wakai
Kazuhito Yajima, Tatsuo Kanda, Shin-ichi Kosugi, Yosuke Kano, Takashi Ishikawa, Hiroshi Ichikawa, Takaaki Hanyu, Toshifumi Wakai, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
Author contributions: Yajima K performed this surgery and rote the paper; Kanda T and Kosugi S contributed assistant of this surgery; Kano Y, Ishikawa T, Ichikawa H and Hanyu T coordinated the surgery; Wakai T contributed the final coordination of this paper.
Correspondence to: Kazuhito Yajima, MD, PhD, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata 951-8510, Japan. yajikazu@nifty.com
Telephone: +81-25-2272228 Fax: +81-25-2270779
Received: June 13, 2014
Revised: October 9, 2014
Accepted: November 17, 2014
Published online: December 27, 2014
Processing time: 195 Days and 10.7 Hours
Abstract

AIM: To demonstrate a new surgical technique of lower mediastinal lymphadenectomy and intrathoracic anastomosis of esophagojejunostomy using OrVil™.

METHODS: After a total median phrenotomy, the supradiaphragmatic and lower thoracic paraesophageal lymph nodes were transhiatally dissected. The esophagus was cut off using a liner stapler and OrVil™was inserted. Finally, end-to-side esophagojejunostomy was created by using a circular stapler. From July 2009, we adopted this surgical technique for five patients with gastric cancer involving the lower esophagus.

RESULTS: The median operation time was 314 min (range; 210-367 min), and median blood loss was 210 mL (range; 100-838 mL). The median numbers of dissected lower mediastinal nodes were 3 (range; 1-10). None of the patients had postoperative complications including anastomotic leakage and stenosis. The median hospital stay was 16 d (range: 15-20 d). The median length of esophageal involvement was 14 mm (range: 6-48 mm) and that of the resected esophagus was 40 mm (range: 35-55 mm); all resected specimens had tumor-free margins.

CONCLUSION: This surgical technique is easy and safe intrathoracic anastomosis for the patients with gastric adenocarcinoma involving the lower esophagus.

Keywords: Gastric cancer; Esophageal invasion; Lower mediastinal lymphadenectomy; OrVil™; Intrathoracic anastomosis

Core tip: We report a new technique of lower intrathoracic anastomosis through the transhiatal approach using OrVil™ for five patients with gastric adenocarcinoma involving the esophagus. This surgical technique is an easy and safe method to create lower intrathoracic anastomosis.