Ivor Lewis esophagectomy

概述

Ivor Lewis esophagectomy (uh-sof-uh-JEK-tuh-me) is a surgical procedure to remove some or all of the tube connecting the mouth to the stomach, called the esophagus. The procedure is a type of transthoracic esophagectomy. Ivor Lewis is the name for an esophagectomy where surgical incisions are made in the chest and abdomen.

Once the esophagus is removed, it is then reconstructed using part of another organ, usually the stomach.

This surgery may be done to treat esophageal cancer in the lower part of the esophagus. An esophagectomy also may be recommended when conditions that are not cancer affect the esophagus, and attempts to save the esophagus have failed. This can happen with end-stage achalasia or other conditions.

Types

The decision to have an Ivor Lewis esophagectomy is often based on the tumor location if it's done to treat cancer. For an Ivor Lewis procedure, the surgeon chooses an open or minimally invasive surgical technique.

• Open technique. This means making one or more cuts, called incisions, in the chest and abdomen.
• Minimally invasive. This involves several small incisions. They may be in the abdomen, called laparoscopic surgery, or the chest, called thoracoscopic surgery, or both. This procedure may be robot-assisted.

Talk with your care team if you have questions about which surgery is suggested.

目的

Esophagectomy is often done to treat esophageal cancer. During Ivor Lewis esophagectomy, the surgeon removes all or part of the esophagus through a cut in the right side of the chest and the abdomen. A portion of the upper stomach may be removed as well.

风险

The risks of Ivor Lewis procedures include:

• Respiratory complications, such as pneumonia.
• Leakage from the surgical connection of the esophagus and stomach.

The surgical risks also include:

• Bleeding.
• Leakage of lymph fluid, called chyle, from the chest.
• Blood clots.
• Infection.

After this surgery, there is a risk of:

• Difficulty swallowing, called dysphagia.
• Heart issues, including atrial fibrillation.
• Acid or bile reflux.
• Digestive issues such as delayed gastric emptying.

There is a risk of death with any esophagectomy, including Ivor Lewis procedures.

如何进行准备

Your doctor and healthcare team will discuss concerns you may have about your Ivor Lewis esophagectomy. If you have cancer, your doctor may recommend chemotherapy or radiation or both, followed by a period of recovery, before a surgery to remove the esophagus. These decisions will be made based on the stage of your cancer.

If you smoke, your doctor will ask you to quit and may recommend a program to help you quit. Smoking increases your risk of complications after surgery.

Before the Ivor Lewis procedure, your care team may ask about what you eat and drink. This nutritional assessment helps make sure the diet you follow gives you the nutrients you need. For some people, this may mean that nutrition is delivered by feeding tube.

Your care team also may ask about medicines you take to manage blood sugar or blood pressure or to limit alcohol intake.

Talk to your care team about:

• Allergies or reactions. This includes reactions to anesthesia that you or anyone in your family may have had.
• Medicines. The timing of when you take your regular medicines is important before surgery. This is especially true if you are taking any blood thinners. The care team can tell you how to take any medicines on the day of the procedure.
• Food and drink. For anesthesia, you often need to stop eating or drinking at a certain time before the surgery.
• What to bring with you before surgery. This may include a list of your medicines, a copy of your advance directive and any personal care items. This may include eyeglasses instead of contacts, hearing aids, a robe or items to help you relax, such as a book.

Before surgery, talk to your caregivers about your hospital stay and discuss help you may need when you return home. Your doctor and treatment team may give you specific instructions to follow during your recovery when you return home.

可能出现的情况

Before the procedure

Before the Ivor Lewis esophagectomy procedure, you are often asked to change out of your clothes and into a surgical gown. A team of medical professionals helps you get ready. They may remove hair and clean the areas where the surgeon will make incisions. They also may place a catheter to collect urine during the surgery.

During the procedure

The Ivor Lewis procedure happens while you are under anesthesia. Using the open technique or minimally invasive approach, the surgeon removes some or most of the esophagus.

If cancer is involved, part of the stomach and nearby lymph nodes may be removed. Once the cancer is removed, the remaining stomach may be pulled up to attach to the remaining esophagus. In some circumstances, part of the intestine may be pulled up and connected to the esophagus.

The surgery may take several hours. Ask your care team how long they expect it to take for you.

After the procedure

After the Ivor Lewis procedure, you may have a drain placed in the chest to allow fluid to come out. You also may have a tube that goes from the nose into the stomach. Pain is managed with medicine based on your needs and medical conditions.

The hospital stay after esophagectomy depends on your surgery, how well you heal and if you have other medical conditions. Your care team considers your bowel function and how well your pain is controlled.

Your healthcare team may test how well you can swallow. The care team also may test the new junction between the stomach and the remaining esophagus for evidence of leaks. That can help determine when you can begin eating food by mouth. Although swallowing may be difficult at first, it often gets easier over time.

You may be asked to follow a clear liquid diet first, then a liquid diet.

Scarring from esophagectomy depends on the type of surgery you had. Talk to your care team about what to expect and how to care for surgical incisions.

结果

Over time, many people report improved quality of life after surgery to remove all or part of the esophagus. But some symptoms usually continue. In the years after this procedure, people may have challenges with digestion, have difficulty swallowing, and experience breathlessness and fatigue.

Your doctor will likely recommend comprehensive follow-up care to prevent complications after surgery and to help you adjust your lifestyle. Follow-up care may include nutritional support to help with weight loss.

For some people, nutrition may be given through a small tube placed through the abdomen that connects to the stomach or small bowel.

Once you resume a regular diet, you will likely need to eat more frequently, with smaller quantities. You may lose weight after surgery. Your care team can suggest protein-rich options to help you gain or maintain your weight.

If you have reflux, vomiting after eating or trouble swallowing, talk to your healthcare team. Changing what you eat, changing some medicines and following some guidelines when you eat may help. For example, do not lie flat at night, and sit upright while eating.

If you have any questions about what to expect after Ivor Lewis esophagectomy, talk with your care team.