Most Common Esophageal Cancer Surgery Type
The Ivor Lewis esophagogastrectomy (Option B) is the most frequently performed and standard procedure for esophageal cancer surgery, particularly for distal and mid-thoracic tumors. 1
Guideline-Based Evidence
The National Comprehensive Cancer Network explicitly identifies the Ivor Lewis esophagogastrectomy as "the most frequently used procedure for transthoracic esophagogastrectomy," performed using laparotomy and right thoracotomy with upper thoracic esophagogastric anastomosis at or above the azygos vein. 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. 2, 1
Technical Details of Each Approach
Ivor Lewis Procedure (Most Common):
- Uses right thoracotomy and laparotomy with intrathoracic anastomosis 1
- Involves abdominal and right chest access with gastric tube conduit reconstruction and oesophagogastric anastomosis in the upper mediastinum 2
- Suitable for lesions at any thoracic location, though proximal margin may be inadequate for middle esophageal tumors 1
- Represents the most common approach for transthoracic resection 1
Transhiatal Esophagectomy (Option C):
- Performed through abdominal and cervical incisions without thoracotomy 1
- Reserved for frail patients with distal tumors, offering lower morbidity but at the cost of less extensive lymphadenectomy 2
- Not the standard or most common approach 2, 1
Thoracoabdominal Gastrectomy (Option A):
- Uses contiguous abdominal and left thoracic incision 1
- Primarily reserved for distal esophageal lesions 1
- Less commonly performed than Ivor Lewis 1
Clinical Context
The choice between approaches depends on tumor location, with the Ivor Lewis being preferred for distal tumors (the most common location for esophageal adenocarcinoma). 1 For mid and upper esophageal tumors, the McKeown procedure (three-field approach) may be preferred over the standard Ivor Lewis. 2, 1
Modern Practice Patterns
Minimally invasive Ivor Lewis esophagectomy 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. 2, 1 This further solidifies the Ivor Lewis as the dominant surgical approach in contemporary practice. 3, 4