Ivor Lewis esophagectomy is considered to be a rather complex procedure in terms of implementation and duration ( an average 7-8 hours) and is performed for cancer involving the middle and lower third of esophagus, as well as in cardioesophageal cancer. Wherein the stomach is fully mobilized. Piloroplasty or piloromyatomy is performed. The distal esophagus is mobilized through the opening of the diaphragm. The stomach is moved to the posterior mediastinum, however it can also be moved to the neck substernally. From the greater curvature of stomach is cut out a double-end graft. Esophagus is extracted from the posterior mediastinum through a right sided thoracotomy, it is crossed, the stomach is led out through the diaphragmatic opening. Then antireflux anastomosis is applied. Consistency of anastomosis is checked with barium meal after 5-7 days.
In MC Erebouni two such kind complicated surgeries have been successfully carried out during the last months of this year.
The patient K.P., y/b 1958, in 16.10.2017 was admitted to the General & Thoracic Surgery Department of MC Erebouni with complaints of difficulty swallowing, nausea, mild pain in epigastrium , general weakness.
After gastroscopy and CT scan neoplasm of the lower third of the esophagus with invasion to cardiac orifice was detected. Para-esophageal and paraaortic lymph nodes were enlarged (about 1.2 cm). The presence of malignant neoplasm in patient was confirmed by biopsy.
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In 19.10.2017 the patient was performed Ivor Lewis esophagectomy with lymphodissection by the team of general and thoracic surgeons including: A. S. Vardanyan, MD, PhD; A. B. Aleksanyan, MD; N.E. Zaqaryan, G.S. Soghomonyan, anesthesiologist A.M. Hovhannisyan, under supervision of Head of General & Thoracic Surgery Department of MC Erebouni A. R.Asatryan , MD,PhD..
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Similar surgical intervention by the same team of surgeons under supervision of Head of General & Thoracic Surgery Department of MC Erebouni A. R.Asatryan , MD,PhD. was performed in May , 2017. The patient A.G., 1950 y/b, was diagnosed cancer involving the middle and lower third of esophagus with invasion to posterior wall of stomach, enlarged lymph nodes (1.1 cm) in paragastric region.
The postoperative period in both patients was uneventful, they were discharged with improvement for an outpatient monitoring of the surgeon and oncologist. A month later, as a result of another outpatient monitoring, positive results were noted, without complications and relapse of underlying disease. Both patients are currently undergoing adjuvant chemotherapy.
According to statistics, Ivor Lewis esophagectomy is rarely implemented, since it is accompanied by high complication rate and mortality. However, the implementation of above described intervention is just necessary in order to save the patient`s life. Doctors and medical staff of MC Erebouni proved, that professional work at the operating table is another victory over the terrible disease!
