Ivor Lewis esophagectomy

Ivor Lewis esophagectomy

Anesthesia type	General
Airway	DLT
Lines and access	Large PIV, arterial line, NG tube
Monitors	Standard, arterial line
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
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Provide a brief summary of this surgical procedure and its indications here.

Preoperative management

Patient evaluation

System	Considerations
Neurologic
Cardiovascular
Respiratory
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Operating room setup

• Arterial line +/- flowtrack (ideally on left arm)
• Fluid warmer
• Double-lumen tube (left) / bronchial blocker with SLT

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

Positioning

• Start in supine position if EGD is used
• Patient will be later positioned to left lateral decubitus

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 anastamosis is performed and esophogus and stomach returned to mediastinum

Postoperative management

Disposition

• Post-op ICU

Pain management

• Epidural

Procedure variants

	Open	Laparoscopic	Robotic
Unique considerations
Position		Supine then 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%)