Ivor Lewis Esophagectomy (Laparotomy, Right Thoracotomy with Thoracic Anastomosis)

Abstract

The choice of the approach for esophagectomy (Ivor Lewis vs McKeown vs transhiatal esophagectomy) depends on the location of the tumor, prior operations, radiation treatment, body habitus, and surgeon’s preference. A transthoracic approach (Ivor Lewis and McKeown) allows dissection of the difficult esophagus under direct vision and may improve extent of lymphadenectomy and radial margin for midesophageal tumors. Cervical anastomosis in the McKeown and transhiatal approach allows for anastomosis healing outside of the radiated field for middle- and lower-third esophageal tumors, but a thoracic anastomosis (Ivor Lewis) puts less tension on the gastric conduit. There is no oncologic survival difference between these approaches. The Ivor Lewis resection combines a thoracic dissection with a thoracic anastomosis and is described in this chapter. This chapter lists the indications, essential steps, variations, and complications of Ivor Lewis esophagectomy. It includes a detailed template operative dictation note.