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World J Gastroenterol. Aug 28, 2008; 14(32): 5084-5089
Published online Aug 28, 2008. doi: 10.3748/wjg.14.5084
Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy for squamous cell carcinoma of the lower thoracic esophagus
Jie Wu, Ying Chai, Xing-Ming Zhou, Qi-Xun Chen, Fu-Lai Yan
Jie Wu, Xing-Ming Zhou, Qi-Xun Chen, Fu-Lai Yan, Department of Thoracicoabdominal Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
Ying Chai, Department of Thoracic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
Author contributions: Wu J and Chai Y designed the research; Wu J, Zhou XM, Chen QX and Yan FL performed the research; Wu J analyzed the data and wrote the paper.
Correspondence to: Jie Wu, MD, Department of Thoracico-abdominal Surgery, Zhejiang Cancer Hospital, 38 Guangji Road, Bangshan, Hangzhou 310022, Zhejiang Province, China. wujiephd729@126.com
Telephone: +86-571-88122031 Fax: +86-571-88122508
Received: April 17, 2008
Revised: August 11, 2008
Accepted: August 18, 2008
Published online: August 28, 2008
Abstract

AIM: To evaluate the clinical outcome of Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy for patients with squamous cell carcinoma of the lower thoracic esophagus.

METHODS: From January 1998 to December 2001, 73 patients with lower thoracic esophageal carcinoma underwent Ivor-Lewis subtotal esophagectomy with two-field lymphadenectomy. Clinicopathological information, postoperative complications, mortality and long term survival of all these patients were analyzed retrospectively.

RESULTS: The operative morbidity and mortality was 15.1% and the mortality was 2.7%. Lymph node metastases were found in 52 patients (71.2%). Nodal metastases to the upper, middle, lower mediastini and upper abdomen were found in 13 (17.8%), 15 (20.5%), 30 (41.1%), and 25 (34.2%) patients, respectively. Postoperative staging was as follows: stageI in 5 patients, stage II in 34 patients, stage III in 32 patients, and stage IV in 2 patients, respectively. The overall 5-year survival rate was 23.3%. For N0 and N1 patients, the 5-year survival rate was 38.1% and 17.3%, respectively (χ2 = 22.65, P < 0.01). The 5-year survival rate for patients in stages IIa, IIb and III was 31.2%, 27.8% and 12.5%, respectively (χ2 = 29.18, P < 0.01).

CONCLUSION: Ivor Lewis subtotal esophagectomy with two-field (total mediastinum) lymphadenectomy is a safe and appropriate operation for squamous cell carcinoma of the lower thoracic esophagus.

Keywords: Esophageal neoplasm, Ivor Lewis approach, Two-field lymphadenectomy