Ivor Lewis operation for epidermoid carcinoma of the esophagus

One hundred patients, 95 men and 5 women with a mean age of 59 years (age range, 35 to 77 years), were treated by the same initiate surgeon in practice from 1982 to 1988 for epidermoid carcinoma of the lower two-thirds of the esophagus using the Ivor Lewis procedure. Fifty-eight tumors were located in the middle third of the esophagus and 42, in the lower third. Postoperative staging revealed 30 stage I/II and 70 stage III carcinomas (ie, tumors extending beyond the esophageal wall or lymph node extension). Operative procedure was considered curative in 70 patients and palliative in 30 patients. The same procedure has been used for all patients. In all patients we were able to perform extended esophagectomy with anastomosis located 3 to 7 cm under the pharyngoesophageal junction. Postoperative mortality was 4%. Morbidity due to leakage was 7%; proper drainage enabled spontaneous healing in 5 patients. Fifteen patients had pulmonary complications, none of which fatal, Median actuarial survival was 17 months. Actuarial survival at 24 months is significantly higher for patients in stage I and II (68.4%) than for patients in stage III (23.2%) (p less than 0.01). The Ivor Lewis procedure is a safe surgical approach for the treatment of the esophageal carcinoma that has a high survival rate and allows a good quality of life.