• Jiaqing Xiang and Longsheng Miao.
• Chest. 2014 Mar 1;145(3 Suppl):58A.

Session TitleThoracic SurgerySESSION TYPE: Slide PresentationsPRESENTED ON: Saturday, March 22, 2014 at 09:00 AM - 10:00 AMPURPOSE: To examine the morbidity, mortality, and efficacy of an Ivor Lewis esophagectomy for esophageal carcinoma , we reviewed our experience.MethodsA retrospective review of all Ivor Lewis esophagectomies for cancer from 2006 to 2012 (n=1342) was performed. Two time periods were compared: period I (January 2006 to December 2010) and period II (January 2011 to December 2012).Logistic regression analyses determined independent predictors of anastomotic leakage, pneumonia, chylothorax and death.ResultsIvor Lewis esophagectomies for cancer were performed in 49.7% of all esophagectomies . The median age was 60 years , with a male to female ratio of 4.5:1 and a predominance of squamous cell carcinoma (95.4%). Operative mortality was 1.0%; 28.7% experienced complications, including pneumonia(11.5%), anastamotic leak (3.8%), and chylothorax (2.5%). Only pneumonia was predictive of mortality(P<0.001),which was associated with a 7.1% incidence of death and responsible for 43% of deaths. Predictive factor of anastamotic leak was BMI <18.5(P=0.023). Factor predictive of pneumonia was long operation duration (P=0.021). High BMI(BMI>=25) was an adverse predictor of chylothorax (P=0.032). When period I and II were compared, pneumonia reduced from 13.2% to 9.4%(p=0.039), with correspondingly shorter hospital stay (P<0.001) and shorter operation durations(P<0.001). The lower thoracic esophageal cancers were more likely to metastasize to the abdominal cavity (P<0.001) and lower mediastinum(P<0.001) than middle thoracic esophageal cancers.ConclusionsIvor Lewis esophagectomy for esophageal cancer can be performed with a low mortality rate (1.0%) and an acceptable morbidity rate (28.7%). Pneumonia is the predictor of mortality. Underweight is associated with increased anastomotic leak rates. High BMI is associated with decreased incidence of chylothorax . Abdominal and lower mediastinal lymph node dissection should be conducted more vigorously for lower thoracic esophageal cancers.Clinical ImplicationsRecently, MIE(minimally invasive esophagectomy )have been adopted in an attempt to decrease the morbidity and mortality of open esophagectomy. To establish a benchmark for open esophagectomy prior to the widespread use of MIE, we reviewed our experience with the Ivor Lewis procedure.DisclosureThe following authors have nothing to disclose: Longsheng Miao, Haiquan Chen, Jiaqing Xiang, Yawei Zhang, Bin LiNo Product/Research Disclosure Information.

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