Minimally Invasive Intrathoracic Esophagogastric Side to Side Anastomosis vs. End to Side Anastomosis

Inclusion Criteria: The clinical staging of pathological and imaging diagnosis was cT1b-4a, N0-2, M0 stage of lower thoracic esophageal squamous cell carcinoma or Siewert type I and Siewert type II esophageal gastric junction adenocarcinoma (8th UICC-TNM staging); The lesion is potentially resectable; CT3-4a and/or N+patients receive neoadjuvant therapy with the informed consent of patients and their families Comprehensive evaluation is suitable for Ivor Lewis operation Aged 18-75 years, both male and female; There was no contraindication in the preoperative examination and evaluation of various organ functions; The following laboratory tests confirmed that the bone marrow, liver and kidney functions and blood coagulation met the requirements for participating in the study: Hemoglobin ≥ 9.0g/L; White blood cell count ≥ 4.0 × 109/L； Absolute neutrophil count (ANC) ≥ 1.5 × 109/L； Platelet count ≥ 100 × 109/L； The international standardized ratio of prothrombin time ≤ 1.5 times the upper limit of normal value, and part of the thromboplastin time is within the range of normal value; Serum creatinine (SCr) ≤ 1.5 times the upper limit of normal value or creatinine clearance ≥ 50 ml/min (Cockcroft Gault formula); Total bilirubin (TBIL) ≤ 1.5 times the upper limit of normal value (ULN); The level of AST or ALT ≤ 2.5 times the upper limit of normal value (ULN); Urine protein<2+; If the urine protein ≥ 2+, the 24-hour urine protein quantitative display must be ≤ 1g; Lung function: FEV1 ≥ 1.2L, FEV1% ≥ 50% and DLCO ≥ 50% Estimated lifetime ˃ 12 months. R0 resection is expected; The color Doppler ultrasound of the neck showed no suspicious metastatic lymph nodes; Generally in good condition, individual machine energy meter (Karnofsky score, KPS) ≥ 70; Physical status ECOG 0-2 points; The subjects were fully informed of the purpose of the study, voluntarily joined the study, with good compliance, safety and survival follow-up. Exclusion Criteria: Patients with cervical and upper middle thoracic esophageal cancer or Siewert III esophageal gastric junction cancer; Patients with T4b stage inoperable, multiple lymph node enlargement (estimated metastasis ≥ 3), multistation lymph node enlargement (estimated lymph node metastasis ≥ 2) or distant metastasis (M1); Those who can not use stomach to replace esophagus in this operation due to previous operation Previous history of other malignant tumors; Pathological examination of non squamous and non adenocarcinoma patients; Preoperative neoadjuvant chemotherapy and radiotherapy; Severe emphysema and pulmonary fibrosis; Confirmed history of congestive heart failure; Angina pectoris with poorly controlled medication; Transmural myocardial infarction confirmed by electrocardiogram (ECG); Poor control of hypertension; Valvular heart disease with clinical significance; Or high risk uncontrollable arrhythmia; Serious uncontrolled systemic diseases, such as active infection or poorly controlled diabetes; Abnormal coagulation function (PT>16s, APTT>43s, TT>21s, Fbg>2g/L), bleeding tendency (such as active peptic ulcer) or receiving thrombolytic or anticoagulant treatment; Those who already have or are associated with hemorrhagic diseases; People with peripheral nervous system disorder or obvious mental disorder and central nervous system disorder