Difference between revisions of "Ivor Lewis esophagectomy"
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The Ivor-Lewis transthoracic esophagectomy can be used to resect cancers in the lower third of the esophagus. It is not the optimal approach for cancers located in the middle third because of the limited proximal margin that can be achieved. This procedure combines a laparotomy with a right thoracotomy and an intrathoracic esophagogastric anastomosis. This approach permits direct visualization of the thoracic esophagus and allows the surgeon to perform a full thoracic lymphadenectomy. | |||
== Preoperative management == | == Preoperative management == | ||
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=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | === Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | ||
* Thoracic epidural | * Thoracic epidural (T7-8 commonly) | ||
== Intraoperative management == | == Intraoperative management == | ||
Latest revision as of 05:55, 1 July 2022
Ivor Lewis esophagectomy
| Anesthesia type |
General |
|---|---|
| Airway |
DLT / bronchial blocker |
| Lines and access |
Large PIV, arterial line, NG tube |
| Monitors |
Standard, arterial line |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
The Ivor-Lewis transthoracic esophagectomy can be used to resect cancers in the lower third of the esophagus. It is not the optimal approach for cancers located in the middle third because of the limited proximal margin that can be achieved. This procedure combines a laparotomy with a right thoracotomy and an intrathoracic esophagogastric anastomosis. This approach permits direct visualization of the thoracic esophagus and allows the surgeon to perform a full thoracic lymphadenectomy.
Preoperative management
Operating room setup
- Arterial line +/- flowtrack (ideally on left arm)
- Fluid warmer
- Double-lumen tube (left) / bronchial blocker with SLT
Regional and neuraxial techniques
- Thoracic epidural (T7-8 commonly)
Intraoperative management
Monitoring and access
- Invasive hemodynamic monitoring
- Large bore IV access
Induction and airway management
- May consider RSI if high-aspiration risk due to esophageal tumor obstructing food passage
- Left sided double lumen tube or single lumen ETT with bronchial blocker for one lung ventilation
- NGT placed after airway management
Positioning
- Start in supine position if EGD is used at the beginning of the case
- Patient will be later positioned to left lateral decubitus for the thoracic portion of the resection
Maintenance and surgical considerations
Abdominal Dissection
- Pt is placed supine and peritoneal cavity is examined for metastatic disease
- Lower portion of the stomach is mobilized
- Gastric conduit formed
- A cervical anastomosis is performed and esophagus and stomach returned to mediastinum
Emergence
Postoperative management
Disposition
- Post-op ICU
Pain management
- Epidural
Potential complications
- Anastomotic leak
- Vocal cord paresis
- Recurrent laryngeal nerve injury
- Morbidity requiring re-operation
- Mortality
Procedure variants
| Open | Laparoscopic | Robotic | |
|---|---|---|---|
| Unique considerations | |||
| Position | Supine followed by left
lateral decubitus |
||
| Surgical time | |||
| EBL | |||
| Postoperative disposition | ICU | ICU or ERAS | ICU or ERAS |
| Pain management | Thoracic Epidural | Thoracic Epidural | Thoracic Epidural |
| Potential complications | Anastamotic leak (4.3%)
Vocal cord paresis (0.9%) Mortality (1.68%)[1] |
References
- ↑ Luketich, James D.; Pennathur, Arjun; Awais, Omar; Levy, Ryan M.; Keeley, Samuel; Shende, Manisha; Christie, Neil A.; Weksler, Benny; Landreneau, Rodney J.; Abbas, Ghulam; Schuchert, Matthew J. (2012-07). "Outcomes after minimally invasive esophagectomy: review of over 1000 patients". Annals of Surgery. 256 (1): 95–103. doi:10.1097/SLA.0b013e3182590603. ISSN 1528-1140. PMC 4103614. PMID 22668811. Check date values in:
|date=(help)
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