184. intrathoracic side-overlap esophagogastrostomy during minimally invasive esophagectomy for esophagogastric junction cancer

Abstract Backgrounds Surgical algorithm for esophagogastric junction cancer have been proposed according to the results of a recent prospective study. However, reconstruction method has yet to be standardized. Esophagogastrostomy is often performed for esophagogastric junction cancer with esophageal invasion, although, it has been related to frequent and severe complications. Recently, we have introduced IntraThoracic Side-overlap EsophagoGastrostomy (ITS-EG), an eazy and novel intrathoracic anastomotic method with reflux prevention mechanism during minimally invasive esophagectomy for esophagogastric junction cancer. Methods We retrospectively reviewed patient backgrounds and surgical/short term outcomes for the patient who underwent ITS-EG during minimally invasive esophagectomy for esophagogastric junction cancer between February 2018 to April 2023 at our institute. Results The study cohort included ten patients, with a median age of 67 (55–77) years. All tumors were classified as Siewert type II, and the median esophageal invasion length was 32 (11.8–40) cm. After extended proximal gastrectomy, patients underwent either thoracoscopic (five patients) or robot-assisted (five patients) minimally invasive esophagectomy followed by ITS-EG. ITS-EG consist of overlap anastomosis utilizing surgical stapler, and reflux prevention mechanism owing to the creation of pseudo-fornix and a slit-shaped anastomosis. The initial case suffered anastomotic leakage, however, recovered by conservative measures. All the other patients had an uneventful recovery without reflux esophagitis nor anastomotic stricture. Conclusion ITS-EG is an easy and safe esophagogastric anastomosis with reflux prevention mechanism during minimally invasive esophagectomy, and may be considered for esophagogastric junction cancers with esophageal invasion. Further accumulation of cases is needed to demonstrate the safety and efficacy of ITS-EG. Surgical procedure for ITS-EG would be presented by video.