Abstract
Background
The Ivor Lewis procedure consists of open subtotal esophagectomy and intrathoracic esophago-gastric anastomosis. Though this procedure is open surgery, it can minimize the risk of anastomotic leakage. This procedure combined with aggressive upper mediastinal lymph node dissection could achieve satisfactory short-term and long-term outcomes.
Methods
The cases with middle or lower thoracic cancer without metastasis at the cervical area are subjected to this Ivor Lewis procedure. To evade the demerit of thoracotomy, we have employed 1) the 3-field lymphadenectomy in selective patients, 2) the vertical muscle-sparing thoracotomy without transection of muscles and ribs, 3) paravertebral block for postoperative pain.
Results
A total of 246 patients who underwent subtotal esophagectomy (2011.1–2016.12) were analyzed for short-time postoperative outcomes. In 135 patients of the Ivor-Lewis group, prevalence of anastomotic leakage, anastomotic stricture recurrent nerve palsy and the morbidity, defined as Clavien-Dindo classification 2 or further, was 0%, 0.7% and 21% respectively. On the other hand, the incidence of these increased significantly in 111 patients who underwent cervical anastomosis, 10%, 6.3% and 47% respectively. Though Ivor-Lewis was open surgery, 83% patients in the Ivor Lewis group achieved 30 m walking at the ward within postoperative day 2 and the median length of postoperative hospital stay was 16 days (10–83). The survival according to our therapeutic strategy was analyzed in 352 patients who underwent subtotal esophagectomy for thoracic esophageal cancer (2002.1–2012.12). The overall survival was 82.5/83.5/52.1/50.0/32.1% for stage0/I/II/III/IVa (JES10th). The solitary cervical lymph node recurrence was diagnosed in 5 patients of Ivor-Lewis group, but 4 of the patient could be cured by additional cervical lymph node dissection.
Conclusion
Discussion: Intrathoracic anastomosis could minimize the risk of anastomotic leakage, and consequently the total complication rate could be reduced. The strategy that the cervical lymphadenectomy is performed only through the thoracic cavity in the selected patients was acceptable because of our survival data.
Conclusion: Using our Ivor-Lewis procedure for the patients with thoracic esophageal cancer, even the open operation can minimize the risk of complication. Out therapeutic strategy could achieve satisfactory survival results.
Disclosure
All authors have declared no conflicts of interest.
Subtotal esophagectomy with extended 2-field lymph node dissection for thoracic esophageal cancer
