c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Ivor-Lewis Esophagectomy: 1

A D V E R T I S E M E N T

   
 

An 82-year-old woman presented with difficulty swallowing (dysphagia) and pain on swallowing (odynophagia). Upper endoscopy showed a lesion of the mid esophagus (22-26cm from the incisors). Biopsy showed squamous cell carcinoma. The patient was a non-smoker and non-drinker, but consumed several cups of hot tea per day.      

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Ivor-Lewis Esophagectomy: 2

A D V E R T I S E M E N T

   
 

The CT scan showed thickening of the mid esophagus at the level of the left main stem bronchus. There was no evidence of disease elsewhere in the chest or in the abdomen. Trans-esophageal echography showed the lesion extending to the serosa (T3), and no notable adenopathy.      

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Ivor-Lewis Esophagectomy: 3

A D V E R T I S E M E N T

   
 

The patient was given the option of radiation therapy or surgical resection as equivalent treatments, and the patient opted for surgery. The patient was advised that surgical resection carries an overall 5-year survival rate of approximately 20%, and that resection is usually palliative. An Ivor Lewis esophagectomy was chosen over a transhiatal approach for this patient. In the operating room, esophagoscopy was repeated, and bronchoscopy was performed to rule out the presence of a tracheo-esophageal fistula. The patient was positioned supine first, and the abdomen was opened through an upper midline incision.     

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This page was last modified on 2/28/2002.