Cardiothoracic Surgery |

Ivor Lewis Esophagectomy for Esophageal Cancer: Review of Over 1,300 Patients FREE TO VIEW

Longsheng Miao, MD; Haiquan Chen, PhD; Jiaqing Xiang, MD; Yawei Zhang, MD; Bin Li, MD
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Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China

Chest. 2014;145(3_MeetingAbstracts):58A. doi:10.1378/chest.1835110
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SESSION TITLE: Thoracic Surgery

SESSION TYPE: Slide Presentations

PRESENTED ON: Saturday, March 22, 2014 at 09:00 AM - 10:00 AM

PURPOSE: To examine the morbidity, mortality, and efficacy of an Ivor Lewis esophagectomy for esophageal carcinoma , we reviewed our experience.

METHODS: A retrospective review of all Ivor Lewis esophagectomies for cancer from 2006 to 2012 (n=1342) was performed. Two time periods were compared: period I (January 2006 to December 2010) and period II (January 2011 to December 2012).Logistic regression analyses determined independent predictors of anastomotic leakage, pneumonia, chylothorax and death.

RESULTS: Ivor Lewis esophagectomies for cancer were performed in 49.7% of all esophagectomies . The median age was 60 years , with a male to female ratio of 4.5:1 and a predominance of squamous cell carcinoma (95.4%). Operative mortality was 1.0%; 28.7% experienced complications, including pneumonia(11.5%), anastamotic leak (3.8%), and chylothorax (2.5%). Only pneumonia was predictive of mortality(P<0.001),which was associated with a 7.1% incidence of death and responsible for 43% of deaths. Predictive factor of anastamotic leak was BMI <18.5(P=0.023). Factor predictive of pneumonia was long operation duration (P=0.021). High BMI(BMI>=25) was an adverse predictor of chylothorax (P=0.032). When period I and II were compared, pneumonia reduced from 13.2% to 9.4%(p=0.039), with correspondingly shorter hospital stay (P<0.001) and shorter operation durations(P<0.001). The lower thoracic esophageal cancers were more likely to metastasize to the abdominal cavity (P<0.001) and lower mediastinum(P<0.001) than middle thoracic esophageal cancers.

CONCLUSIONS: Ivor Lewis esophagectomy for esophageal cancer can be performed with a low mortality rate (1.0%) and an acceptable morbidity rate (28.7%). Pneumonia is the predictor of mortality. Underweight is associated with increased anastomotic leak rates. High BMI is associated with decreased incidence of chylothorax . Abdominal and lower mediastinal lymph node dissection should be conducted more vigorously for lower thoracic esophageal cancers.

CLINICAL IMPLICATIONS: Recently, MIE(minimally invasive esophagectomy )have been adopted in an attempt to decrease the morbidity and mortality of open esophagectomy. To establish a benchmark for open esophagectomy prior to the widespread use of MIE, we reviewed our experience with the Ivor Lewis procedure.

DISCLOSURE: The following authors have nothing to disclose: Longsheng Miao, Haiquan Chen, Jiaqing Xiang, Yawei Zhang, Bin Li

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