Pyloroplasty Improves Short-Term Conduit Drainage Following MIE

Background: Ivor Lewis minimally invasive esophagectomy (MIE) is a complex operation and is often combined with pyloroplasty to improve conduit drainage and morbidity. Several trials and meta-analyses have suggested predictable benefit, but longer-term outcomes are unclear. There are no randomized prospective studies examining the benefit of pyloroplasty after MIE in the modern era. Objective: To evaluate the benefit of adding pyloroplasty to minimally invasive or robotic esophagectomy with gastric conduit construction. Design: Prospective phase III trial. Participants/Methods: The trial was conducted at the University of Pittsburgh with established expertise in minimally invasive foregut surgery service. After stomach mobilization, patients were randomized to undergo pyloroplasty or no pyloroplasty. The primary outcome was a composite end point of postoperative anastomotic leak and pneumonia within 30 days of surgery. Secondary outcomes included delayed gastric emptying and other po more...