Most Common Esophageal Cancer Surgery
The Ivor Lewis esophagogastrectomy is the most frequently used procedure for transthoracic esophagogastrectomy and represents the most common operation type among the standard esophageal cancer surgical approaches. 1
Evidence from Guidelines
The National Comprehensive Cancer Network explicitly states that "Ivor Lewis esophagogastrectomy, the most frequently used procedure for transthoracic esophagogastrectomy" is performed using laparotomy and right thoracotomy, with upper thoracic esophagogastric anastomosis at or above the azygos vein. 1
Standard Surgical Options
The three main approaches for esophageal cancer surgery include:
Ivor Lewis esophagogastrectomy: Uses right thoracotomy and laparotomy with intrathoracic anastomosis, representing the most common approach for transthoracic resection 1
Transhiatal esophagogastrectomy: Performed through abdominal and cervical incisions without thoracotomy, associated with lower morbidity but less extensive lymphadenectomy 1
Thoracoabdominal (left transthoracic) esophagogastrectomy: Uses contiguous abdominal and left thoracic incision, primarily reserved for distal esophageal lesions 1
Clinical Context
The Ivor Lewis procedure is suitable for lesions at any thoracic location, though proximal esophageal margin may be inadequate for tumors in the middle esophagus. 1 The European Society for Medical Oncology confirms that radical transthoracic esophagectomy with en bloc two-field lymphadenectomy is the procedure of choice in fit patients, with the Ivor Lewis approach being the standard for distal tumors. 1
Modern Adaptations
Minimally invasive Ivor Lewis esophagectomy (combining laparoscopy with limited thoracotomy or thoracoscopy) has become increasingly implemented, with three randomized controlled trials demonstrating lower postoperative morbidity, quicker functional recovery, and better quality of life compared to open approaches. 1, 2
Important Caveats
While transhiatal esophagectomy offered early survival advantage in population-based studies, long-term survival was not different between surgical approaches 1
The choice between approaches depends on tumor location, size, stage, surgeon experience, and patient factors 1
For mid and upper esophageal tumors, the McKeown procedure (three-field approach with cervical anastomosis) may be preferred over the standard Ivor Lewis 1
Answer: B. Ivor Lewis oesophagectomy