Skip to main content
Book cover

Surgery for Cancers of the Gastrointestinal Tract pp 3–15Cite as

Open Technique for Ivor Lewis Esophagectomy

  • 2292 Accesses

Abstract

For many years, surgical resection of the esophagus and subsequent reconstruction of enteral continuity was a formidable challenge for surgeons and patients alike. Since the first esophageal resection, much has been learned about the anatomical and physiological aspects of esophagectomy. One type of esophageal resection and reconstruction has been referred to as Ivor Lewis esophagectomy, after a British surgeon who utilized an abdominal incision and right thoracotomy to resect the cancer of the esophagus. Herein, we describe our modified approach with this technique.

Keywords

  • Ivor Lewis
  • Esophagectomy
  • Esophageal cancer
  • Open resection

This is a preview of subscription content, access via your institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-1-4939-1893-5_1
  • Chapter length: 13 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   99.00
Price excludes VAT (USA)
  • ISBN: 978-1-4939-1893-5
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   129.00
Price excludes VAT (USA)
Learn about institutional subscriptions
Fig. 1.1
Fig. 1.2
Fig. 1.3
Fig. 1.4
Fig. 1.5
Fig. 1.6

References

  1. Dubecz A, Schwartz SI. Franz John A. Torek. Ann Thorac Surg. 2008;85(4):1497–9. doi:10.1016/j.athoracsur.2007.10.106.

    PubMed  CrossRef  Google Scholar 

  2. Lewis I. The surgical treatment of carcinoma of the oesophagus; with special reference to a new operation for growths of the middle third. Br J Surg. 1946;34:18–31.

    CAS  PubMed  CrossRef  Google Scholar 

  3. Gaur P, Swanson SJ. Should we continue to drain the pylorus in patients undergoing an esophagectomy? Dis Esophagus. 2013. doi:10.1111/dote.12035.

    PubMed  Google Scholar 

  4. Low DE, Bodnar A. Update on clinical impact, documentation, and management of complications associated with esophagectomy. Thorac Surg Clin. 2013;23(4):535–50. doi:10.1016/j.thorsurg.2013.07.003.

    PubMed  CrossRef  Google Scholar 

  5. Sepesi B, Swisher SG, Walsh GL, Correa A, Mehran RJ, Rice D, et al. Omental reinforcement of the thoracic esophagogastric anastomosis: an analysis of leak and reintervention rates in patients undergoing planned and salvage esophagectomy. J Thorac Cardiovasc Surg. 2012;144(5):1146–50. doi:10.1016/j.jtcvs.2012.07.085.

    PubMed  CrossRef  Google Scholar 

  6. Dasari BV, Neely D, Kennedy A, Spence G, Rice P, Mackle E, et al. The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations. Ann Surg. 2014;259(5):852–60. doi:10.1097/sla.0000000000000564.

    PubMed  CrossRef  Google Scholar 

  7. Martin LW, Hofstetter W, Swisher SG, Roth JA. Management of intrathoracic leaks following esophagectomy. Adv Surg. 2006;40:173–90.

    PubMed  CrossRef  Google Scholar 

  8. Wormuth JK, Heitmiller RF. Esophageal conduit necrosis. Thorac Surg Clin. 2006;16(1):11–22. doi:10.1016/j.thorsurg.2006.01.003.

    PubMed  CrossRef  Google Scholar 

  9. Marks JL, Hofstetter WL. Esophageal reconstruction with alternative conduits. Surg Clin North Am. 2012;92(5):1287–97. doi:10.1016/j.suc.2012.07.006.

    PubMed  CrossRef  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA

    Boris Sepesi M.D. & Wayne L. Hofstetter M.D.

Authors
  1. Boris Sepesi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wayne L. Hofstetter M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wayne L. Hofstetter M.D. .

Editor information

Editors and Affiliations

  1. Division of Surgical Oncology, City of Hope, Los Angeles, California, USA

    Joseph Kim

  2. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Julio Garcia-Aguilar

Key Operative Steps

Key Operative Steps

  1. 1.

    Create upper midline incision from the xiphoid to the umbilicus.

  2. 2.

    Retract the left lobe of the liver anteriorly and superiorly over the gastroesophageal junction.

  3. 3.

    Open the pars flaccida exposing the caudate lobe and right diaphragmatic crus.

  4. 4.

    Incise the phreno-esophageal ligament over the diaphragmatic crus and dissect the crus free from the gastroesophageal junction.

  5. 5.

    Pass a penrose drain around the gastroesophageal junction to aid with dissection.

  6. 6.

    Divide the avascular plane between the omentum and colon. Preserve the entire course of the right gastro-epiploic artery.

  7. 7.

    Create an omental pedicle flap, based on 2–3 perforating omental arterial branches off the right gastro-epiploic artery.

  8. 8.

    Complete gastric mobilization along the greater curvature by dividing short gastric arteries.

  9. 9.

    Perform D2 lymphadenectomy and divide the left gastric vessels.

  10. 10.

    Perform either pyloromyotomy or pyloroplasty.

  11. 11.

    Create the gastric conduit with multiple fires of linear stapler from incisura towards the angle of His.

  12. 12.

    Create feeding jejunostomy 30 cm from the ligament of Treitz.

  13. 13.

    Close the abdomen.

  14. 14.

    Perform right thoracotomy.

  15. 15.

    Mobilize the esophagus by incising the inferior pulmonary ligament, retracting the lung anteriorly and medially, and incising the mediastinal pleura along the anterior surface of the esophagus.

  16. 16.

    Mobilize the subcarinal/level 7 lymph node compartment en bloc with the esophagus.

  17. 17.

    Mobilize the azygos arch and divide it with vascular stapler.

  18. 18.

    Mobilize the esophagus away from the trachea.

  19. 19.

    Incise the posterior pleura anterior to the azygos vein and extend inferiorly to the diaphragmatic hiatus.

  20. 20.

    Ligate the thoracic duct between the spine and aorta at T10.

  21. 21.

    Mobilize the esophagus along the periaortic plane to the left pleura with all periesophageal lymphatic tissues.

  22. 22.

    Divide the esophagus at or above the level of the azygos arch.

  23. 23.

    Purse-string the esophagus around the anvil of the stapler.

  24. 24.

    Create gastrotomy at the tip of the gastric conduit and place the circular stapler into the conduit.

  25. 25.

    Open the stapler extending the spike along the greater curvature of the stomach. Align the anvil with the spike and staple the anastomosis.

  26. 26.

    Amputate the tip of the conduit removing the gastrotomy site.

  27. 27.

    Place the omental pedicle flap between the anastomosis and the airway and circumferentially envelop the anastomosis and gastric staple line.

  28. 28.

    Irrigate the chest cavity and place chest tubes in the pleural spaces.

  29. 29.

    Close thoracotomy incision in routine fashion.

Rights and permissions

Reprints and Permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Sepesi, B., Hofstetter, W.L. (2015). Open Technique for Ivor Lewis Esophagectomy. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1893-5_1

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1893-5_1

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1892-8

  • Online ISBN: 978-1-4939-1893-5

  • eBook Packages: MedicineMedicine (R0)