The original Ivor Lewis two stage esophagectomy revisited in the era of minimally invasive surgery

Background: Esophagectomy has high cardiac and pulmonary complication rates that can reach 43% and 58% respectively. The original Ivor Lewis esophagectomy was a two-stage procedure. We revisited this procedure using a hybrid minimally-invasive approach. Methods: Thirty-five consecutive patients with esophageal cancer were operated on over an eight-year period. The first stage used laparoscopic mobilization of the stomach, while the second stage used open thoracotomy. Six patients were aborted due to unresectable disease. Results: Twenty-nine patients were studied. The mean operative times for stage-one and stage-two were 108 +/- 18 and 226 +/- 63 min respectively. All patients were extubated in the operating room. One (3.4%) patients had cardiac complication and one (3.4%) patient had pulmonary complication. Conclusion: Metachronous hybrid two-stage esophagectomy was associated with a low rate of cardiopulmonary complications. It may be considered as an alternative to the one-stage esophagectomy, especially in low-volume centers, to decrease these high-risk cardio-pulmonary complications. (C) 2018 Elsevier Inc. All rights reserved.