ABSTRACT
Esophageal cancer represents one of the most lethal malignancies affecting mankind. This is compounded by the fact that adenocarcinoma of the esophagus is increasing in incidence at a rate exceeding that of any other neoplasm. At most centers, esophageal resection remains the therapeutic alternative of choice for patients who are considered to be surgical candidates. The surgeons' opinions about Ivor Lewis operation has long been sceptic because of the consequences if leakage of the intra thoracic anastomosis occurred. However, with the advent of stapling devices and with the advances in operative techniques, a well vascularized oesophageal substitute can be prepared and a safe anastomosis can be constructed. In the present work, we managed 17 patients with carcinoma of the lower oesophagus by Ivor-Lewis subtotal esophagectomy with 2 field lymphadenectomy from May 2000 to July 2004. We used the stomach as an oesophageal substitute and a stapled oesophagogastric anastomosis was done at the apex of thorax. The median ICU stay was 2 days [1-38 days] and the median postoperative stay for those patients without complication was 14 days. The proximal longitudinal resection margin was infiltrated in 1 case while 3 cases showed involvement of the circumferential margin. Primary pulmonary complication occurred in 6 patients with 1 related mortality. Leakage occurred in 4 patients, 3 among them were managed conservatively. Three patients died postoperatively [17.6% with only one case died from surgical rather than medical complication], one from acute respiratory distress syndrome, second from profound sepsis following extensive mediastinal leakage and third one from massive myocardial infarction. At the end of the 1[st] postoperative year, 10 patients were alive. It has been concluded that Ivor Lewis operation is a good option for patients with carcinoma of the lower oesophagus and a better outcome depends on early recognition and aggressive management of complications that can minimize subsequent mortality