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[Application of Ivor-Lewis esophagectomy in elderly patients with carcinoma in middle and lower esophagus].

OBJECTIVE
To evaluate the safety of Ivor-Lewis procedure for middle and lower esophageal carcinoma in the elderly.


METHODS
From June 2009 to June 2010, 232 cases aged over 60 years were diagnosed as esophageal carcinoma. These cases were randomly divided into two groups using table of random digits. One group underwent abdominal and right chest approaches for middle and lower esophageal carcinoma (Ivor-Lewis procedure, n=116). The other group underwent posterolateral left thoracal incisions(Sweet procedure, n=116). Intraoperative and postoperative parameters were compared.


RESULTS
The radical resection rates in Ivor-Lewis and Sweet procedure were 95.7% and 92.2% respectively(P>0.05). The time required for opening the thorax was(47.2 ± 5.2) min and (105.4 ± 9.3) min(P=0.000), respectively. The respiratory failure rates were 1.7% and 6.9%(P=0.049). The incidences of supraventricular tachyarrhythmia were 3.4% and 10.3%, respectively. The overall complication rates were 22.4% and 34.5%(P=0.004). The perioperative mortalities were 1.7% and 3.4%(P>0.05). The postoperative ambulation time was (4.0 ± 2.0)d and (4.8 ± 3.7)d(P=0.046). The postoperative time in hospital was (11.5 ± 4.7)d and (13.7 ± 7.8)d(P=0.008).


CONCLUSIONS
Ivor-Lewis procedure is associated with little damage to diaphragm, shorter intrathoracic operative time, minimal influence on cardiopulmonary function, less postoperative complications, and quicker recovery. This procedure should be considered as the first choice for middle and lower esophageal carcinoma in the elderly.