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Updated: Aug 7, 2026
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An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Initial experience with minimally invasive Ivor Lewis esophagectomy
Costas Bizekis1, Michael S Kent, James D Luketich
1Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15232, USA.
The Annals of Thoracic Surgery
|July 26, 2006
Summary
Minimally invasive Ivor Lewis esophagectomy with a high intrathoracic anastomosis is feasible, showing good early results. This technique reduces gastric mobilization and nerve injury for gastroesophageal junction tumors.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Previous experience with minimally invasive esophagectomy using a cervical anastomosis.
- Current study focuses on a modified technique with a high intrathoracic anastomosis.
Purpose of the Study:
- To report early experience with a modified minimally invasive Ivor Lewis esophagectomy.
- To evaluate the feasibility and initial outcomes of a high intrathoracic anastomosis.
Main Methods:
- Performed minimally invasive Ivor Lewis esophagectomy in 50 patients (2002-2005).
- Utilized totally laparoscopic abdominal procedure with minithoracotomy or thoracoscopy for thoracic component.
- Indications included Barrett's esophagus with high-grade dysplasia or resectable gastroesophageal junction adenocarcinoma.
Main Results:
- Operative mortality was 6% with 6% anastomotic leak rate, managed nonoperatively.
- Postoperative pneumonia occurred in 8% of patients; no recurrent laryngeal nerve injuries.
- Conversion to open procedure in one patient during laparoscopy.
Conclusions:
- Minimally invasive Ivor Lewis esophagectomy with high intrathoracic anastomosis is technically feasible.
- The approach offers good initial results, minimizing gastric mobilization and nerve injury.
- Provides potential for increased gastric resection margin for cardia-extended GEJ tumors.
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