• Korean Journal of Clinical Pharmacy
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• v.24 no.4
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• pp.240-247
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• 2014

Objective: Undernutrition is common amongst esophageal cancer patients and therefore appropriate nutrition support is critical. Nevertheless, the effectiveness of enteral nutrition (EN) versus parenteral nutrition (PN) is still controversial. The aim of this study was to investigate the effect of EN and PN on the nutritional state and the length of hospital stay for patients who underwent an Ivor-Lewis (IL) esophagectomy. Method: A retrospective clinical analysis was performed that utilized the electronic medical records of patients who underwent IL esophagectomy during a 3-year period between January 2010 and December 2012 at a tertiary teaching hospital located in Seoul, Korea. The EN group and PN group were analyzed by comparing the nutrition supply, postoperative complications, length of hospital stay, and weight variation. Results: After an IL esophagectomy, the complication rate between the EN group and PN group was insignificant and the length of hospital stay was significantly shorter for the PN group compared to the EN group (14 vs. 16 days, respectively; p<0.001). At the time of discharge, those in the PN group lost less weight postoperatively (p=0.003). Conclusion: PN may be considered as safe nutrition support for esophageal cancer patients who underwent an esophagectomy.

• Journal of Chest Surgery
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• v.37 no.2
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• pp.193-196
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• 2004

Benign gastrobronchial fistula (GBF) after Ivor Lewis operation is a very rare and serious complication. We describe a patient with GBF who was successfully managed on the single-stage repair, 15 months after the Ivor Lewis operation. After the division of the GBF, the bronchial and gastric defects were closed directly. The omental flap and the pedicled 5th. intercostal muscle flap were interposed between the closed defects. The literature of this subject is reviewed and discussed.

• Journal of Chest Surgery
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• v.32 no.1
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• pp.49-52
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• 1999

A 58-year-old male patient visited our hospital for epigastric discomfort and dysphagia which had developed 5 months earlier. He was diagnosed with esophageal cancer at the mid-thoracic level based on radiologic, endoscopic, and histologic examinations. An esophagectomy(Ivor Lewis technique) was done to treat the esophageal cancer. He was doing well until the 20th postoperative day when he began to complain of cough, sputum, fever and chills, Subsequently, thereafter, abdominal pain and generalized abdominal tenderness developed on the 22nd postoperative day. Upon gastrofiberscopy and esophagographic examinations, he was diagnosed with gastrobronchial fistula and an emergency operation was performed. On operative findings, the gastric fundus was perforated and directly connected to the abscessed cavity of the right upper lobe due to a gastric ulcer. We, herewith, report this case after review of the literature.

• Journal of Chest Surgery
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• v.47 no.3
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• pp.313-316
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• 2014

Airway obstruction after esophageal surgery is quite rare, and few such cases have been reported. A 57-year-old woman who underwent the Ivor Lewis procedure for esophageal carcinoma complained of a sudden onset of severe dyspnea on postoperative day 3. Chest computed tomography scan revealed that the collection of a large volume of mediastinal fluid caused marked luminal compression on the trachea and the gastric conduit. Explorative thoracotomy revealed a clear serous fluid in the space between the trachea and the gastric conduit, and all respiratory symptoms were relieved after the fluid was drained. The possibility of tracheal compression by loculated effusion, such as chyloma, should be considered in a patient who complains of respiratory deterioration after esophageal surgery.

• Journal of Chest Surgery
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• v.56 no.5
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• pp.362-366
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• 2023

The stomach has become the most commonly used site for grafts to replace the esophagus in esophageal cancer surgery because of its good blood supply and ability to enable single-reconstruction anastomosis. However, anastomotic failure is a serious complication after esophageal cancer surgery. Unlike anastomotic leakage due to local ischemia, gastric tube necrosis is a life-threatening condition with a high mortality rate. Gastric tube necrosis involves extensive ischemia due to a decreased blood supply, and an urgent operation is mandatory in most cases. Endoscopic vacuum therapy (EVT) has been used for anastomotic leakage after esophageal surgery. In recent years, it has been successfully used for more extensive disease, including large esophageal perforation as an indication for reoperation. Hence, we report a case of extensive gastric tube necrosis treated by EVT after an Ivor Lewis operation.

• Journal of Chest Surgery
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• v.34 no.2
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• pp.189-193
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• 2001

위기관지 누공은 매우 드문 질환으로 대부분의 경우 외상, 상부위장관 수술, 횡경막하 농양, 양성 위궤양, 신생물 등 이 원인으로 생각된다. 식도암의 Ivor Lewis 수술후 2년과 3년에 양성 위궤양으로 인해 발생한 재발성 위기관지 누공 1예를 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• v.49 no.2
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• pp.99-106
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• 2016

Background: Barium swallow is performed following esophagectomy to evaluate the anastomosis for detection of leaks and to assess the emptying of the gastric conduit. The aim of this study was to evaluate the reliability of the barium swallow study in diagnosing anastomotic leaks following esophagectomy. Methods: Patients who underwent esophagectomy from January 2000 to December 2013 at our institution were investigated. Barium swallow was routinely done between days 5-7 to detect a leak. These results were compared to clinically determined leaks (defined by neck wound infection requiring jejunal feeds and or parenteral nutrition) during the postoperative period. The sensitivity and specificity of barium swallow in diagnosing clinically significant anastomotic leaks was determined. Results: A total of 395 esophagectomies were performed (mean age, 62.2 years). The indications for the esophagectomy were as follows: malignancy (n=320), high-grade dysplasia (n=14), perforation (n=27), benign stricture (n=7), achalasia (n=16), and other (n=11). A variety of techniques were used including transhiatal (n=351), McKeown (n=35), and Ivor Lewis (n=9) esophagectomies. Operative mortality was 2.8% (n=11). Three hundred and sixty-eight patients (93%) underwent barium swallow study after esophagectomy. Clinically significant anastomotic leak was identified in 36 patients (9.8%). Barium swallow was able to detect only 13/36 clinically significant leaks. The sensitivity of the swallow in diagnosing a leak was 36% and specificity was 97%. The positive and negative predictive values of barium swallow study in detecting leaks were 59% and 93%, respectively. Conclusion: Barium swallow is an insensitive but specific test for detecting leaks at the cervical anastomotic site after esophagectomy.

• Korean Journal of Clinical Oncology
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• v.14 no.2
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• pp.95-101
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• 2018

Purpose: The standard treatment of esophageal cancer is the Ivor-Lewis operation, which consists of an abdominal phase involving gastric tube formation, and a chest phase involving esophagectomy and anastomosis. We aimed to report our experience of performing thoracic esophagectomy with the laparoscopic gastric pull up (LGPU) technique and its surgical outcomes. Methods: Clinicopathologic data and short-term surgical outcomes of 14 patients who underwent LGPU for thoracic esophageal cancer from August 2008 to May 2016 were retrospectively reviewed. Results: Mean age of the patients was 62.3 years and mean body mass index was $21.7kg/m^2$. Eleven patients had medical comorbidities. Patients' mean American Society of Anesthesiologists score was 2. Mean operation time was 428.5 minutes, with the mean abdominal operation time being 138.9 minutes. There was no open conversion case. Three patients had pneumonia, three patients had surgical site infection, and one patient had subcutaneous emphysema within 30 days after surgery. One patient had minor anastomosis site leakage. There was one 30-day mortality case. One patient with postoperative aspiration pneumonia developed acute respiratory distress disease, and died due to sepsis. Mean postoperative intensive care unit stay was 3.5 days, and mean postoperative hospital stay was 20.6 days. Nasogastric tubes were removed on average at 3.4 days, and mean oral intake time was 3.4 days. Conclusion: If the gastrointestinal surgeon has extensive experience in laparoscopic procedures, LGPU will be a safe and feasible technique for thoracic esophagectomy in patients with intrathoracic esophageal cancer.

• Journal of Chest Surgery
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• v.35 no.4
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• pp.296-302
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• 2002

The classic approach for esophagectomy is via the combined thoracic and abdominal approach. Controversy exists whether patients with esophageal carcinoma are best managed with Ivor-Lewis esophagectomy(ILO) as combined thoracic and abdominal approach or transhiatal esophagectomy(THO). The THO approach is known to be superior with respect to operative time, severity of leak, morbidity/mortality, and length of stay, but may represent an inferior cancer operation as a result of survival disadvantage due to inadequate mediastinal clearance compared with ILO. Accordingly, we reviewed the results of our esophageal resections to compare these outcome parameters for each operative approach. Material and Method: From January 1993 to July 2001, We performed a retrospective review of all esophagectomies performed at Keimyung University Dongsan ·Medical Center; 27 underwent THO, and 45 underwent ILO Result: The two groups were comparable in terms of age, sex, and stage of the disease. Mean tumor length and mean operative time were 3.81cm and 354 minutes for THO versus 5.31cm and 453 minutes for ILO, respectively (p<0.01 and p<0.001). Respiratory complications were 11.1% for THO versus 35.6% for ILO(p<0.05). Hospital mortality was 11.1% for THO versus 22.2% for ILO. There were no significant differences between THO and ILO with respect to other types of complications, amount of blood transfusion, leak and stricture rates, and hospital stay. Overall long-term survival at 5 years was 37%, respectively. Conclustion: There was no significant difference in long-term survival of patients of both operative approach. ILO had significant difference in respiratory complications associated with hospital mortality. Hence, THO is a valid alternative to ILO for well selected patients. And either approach appears to be acceptable depending on the surgeons, preferences and experiences.

• Journal of Chest Surgery
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• v.29 no.5
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• pp.536-541
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• 1996

Between June 1988 and June 1994, twenty five patients with locAlly advanced esophageal carcinoma received preoperative chemotherapy (Cisplatln, 5-Fluorouracil with or without Etoposide) and followed by resection. All patients had clinical evidence of airway involvement or distant Iymphnode involve- ment (M 1 Iymphnode) on bronchoscopy or computed tomographic scans. The major response rate to chemotherapy decided by the postoperative stage was 48% (12125). The resection rate was 92% (23/25) with overall complete resection rate of 72% (18125). Two patients had exploratory laparotomy (thorn- cotomy) only. Thirteen patients had esophagogastrostomy with a combined abdominl and Rt. thoracic approach (Ivor Lewis operation), slx pAtients had transhiatal esophagectomy, four patients had esophagogastrostomy with a combined Rt. thoracotonly & abdominal, cervical approach. There were three postoperative deaths (12%). Follow-up duration was between 3.3 months to 65 months. Median survival ime of resected patients except hospital death was 14.8 months. Actuarial survival at 12, 24 months was 72.9%, 26.2%. Signifi- cant better survival was associated with responder group (postoperative stage less than lIB) (P=0.029). These results demonstrate that 1) Preoperative Cisplatin based combined chemotherapy Produce high response rate, 2) High complete resection rate with acceptable mortality rate occur after preoperative chemotherapy, 3) Better surviL dl can be anticipated if complete resection performed after major re- sponse to preoperative chemotherapy.