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


Provide a brief summary of this surgical procedure and its indications here.

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

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

  1. Anastomotic leak
  2. Vocal cord paresis
  3. Recurrent laryngeal nerve injury
  4. Morbidity requiring re-operation
  5. 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

  1. 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)