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An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
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Thoracoabdominal Esophagectomy: Then and Now.
John O Barron1, Eugene H Blackstone2, Thomas W Rice1
1Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
The Annals of Thoracic Surgery
|January 30, 2024
Summary
Left thoracoabdominal esophagectomy (TAE) can be a safe and effective approach for esophageal cancer when performed at high volumes, showing comparable outcomes to other methods. This study evaluated TAE
Area of Science:
- Surgical Oncology
- Thoracic Surgery
- Esophageal Cancer Research
Background:
- Left thoracoabdominal esophagectomy (TAE) is an open surgical approach for esophageal cancer with debated utility and outcomes.
- This study investigates the global utilization, survival rates, and current institutional outcomes of TAE.
Purpose of the Study:
- To compare worldwide outcomes of TAE versus non-TAE approaches for esophageal cancer.
- To assess the contemporary use and results of TAE at a high-volume institution.
Main Methods:
- Utilized the Worldwide Esophageal Cancer Collaboration database (8854 patients, 2005-2014).
- Employed propensity score-matched analyses comparing worldwide TAE vs. non-TAE and institutional high-volume TAE vs. worldwide non-TAE.
- Analyzed institutional TAE data from 2017-2021 for current outcomes.
Main Results:
- Worldwide TAE patients had more lymph nodes resected (20 vs. 17) but lower 5-year survival (34% vs. 42%) compared to non-TAE.
- High-volume institutional TAE showed similar 3-year survival (52% vs. 54%) to worldwide non-TAE.
- Recent institutional TAE (2017-2021) had low morbidity (5.6% pneumonia) and high survival (98% alive at 30 days).
Conclusions:
- TAE, when performed as a primary approach in high-volume settings, demonstrates comparable outcomes and low morbidity to non-TAE.
- TAE is particularly beneficial for patients with truncal obesity, previous abdominal surgeries, or locally advanced cardia tumors requiring extensive resection.
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