Ivor Lewis esophagogastrectomy for esophageal cancer

Background. To examine the efficacy of the Ivor Lewis esophagogastrectomy f or esophageal carcinoma prior to the widespread use of preoperative chemoth erapy and irradiation, we reviewed our experience. Methods. We reexamined the cases of 220 consecutive patients who underwent an Ivor Lewis esophagogastrectomy for esophageal cancer from January 1992 t hrough December 1995. Results. There were 196 men (89.1%) and 24 women. Median age was 65 years ( range, 29 to 85 years). The results of pathological study showed adenocarci noma in 188 patients (85.5%), squamous cell carcinoma in 31 (14.1%), and le iomyosarcoma in 1 patient (0.5%). Postsurgical staging was as follows: stag e 0 in 10 patients, stage I in 19, stage IIa in 38, stage IIb in 28, stage III in 111, and stage IV in 14. The operative mortality rate was 1.4% (3 pa tients), and complications occurred in 83 patients (37.7%). Follow-up was 9 8.6% complete. Median survival for operative survivors was 1.9 years (range , 32 days to 8.7 years). The overall 5-year survival rate was 25.2%; it was 80% for patients in stage 0, 94.4% for those in stage I, 36.0% for those i n stage IIa, 14.3% for patients in stage IIb, 10% for those in stage III an d 0% for patients in stage IV. Conclusions. Ivor Lewis esophagogastrectomy for esophageal cancer is a safe operation. Long-term survival is stage dependent. The low survival associa ted with advanced cancers should stimulate the search for effective neoadju vant therapy.