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Updated: Sep 7, 2025

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Strategies to decrease morbidity in surgical management of esophageal cancer: a single center experience
Antonia Rizzuto1, Angela Amaddeo1, Cristina Bozzarello1
1Department of Medical and Surgical Science, Magna Græcia University, Catanzaro, Italy.
Background:
In this study we described our experience in decreasing morbidity by performing a few changes during and after the Ivor Lewis esophagectomy.
Methods:
This is a retrospective single center experience comparing a control period (group A) and a study period (group B) in patients who underwent esophagectomy for esophageal cancer (control group: 23; study group: 17). Control group had postero-lateral thoracotomy and a gastric tube without aspiration during postoperative period. Study group had limited lateral muscle sparing thoracotomy and postoperatively the gastric tube was routinely left for 1 week with intermittent aspiration (10 times every two hours for 1 week).
Results:
Average operation time was 312±56 minutes in control period, in study period 189±36 min. Average ICU stay was 10 (7-32) days in the control group, in study group 4 (1-8) days. Anastomotic leak rate was significantly higher in control vs. study group (53.3% vs. 16.6%; P<0.05). Respiratory complications were significantly lower in the study group (47.8% vs. 17.6%).
Conclusions:
The combination of a limited lateral thoracotomy and postoperative intermittent aspiration seem to reduce the rate of respiratory and anastomotic complication after Ivor-Lewis' procedure.
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