Ivor Lewis procedure

Last revised by Lilit Ganjalyan on 16 Jan 2023

Citation, DOI, disclosures and article data

Citation:

Bickle I, Ganjalyan L, Niknejad M, et al. Ivor Lewis procedure. Reference article, Radiopaedia.org (Accessed on 19 Apr 2024) https://doi.org/10.53347/rID-43088

DOI:

https://doi.org/10.53347/rID-43088

Permalink:

https://radiopaedia.org/articles/43088

rID:

43088

Article created:

23 Feb 2016, Ian Bickle ◉

Disclosures:

At the time the article was created Ian Bickle had no recorded disclosures.

View Ian Bickle's current disclosures

Last revised:

16 Jan 2023, Lilit Ganjalyan

Disclosures:

At the time the article was last revised Lilit Ganjalyan had no financial relationships to ineligible companies to disclose.

View Lilit Ganjalyan's current disclosures

Revisions:

21 times, by 11 contributors - see full revision history and disclosures

Systems:

Gastrointestinal

Tags:

refs, general surgery

Synonyms:

Gastric pull-up
Gastric pull up
Ivor Lewis oesophagectomy
Ivor Lewis procedure

Ivor Lewis procedure (also known as a gastric pull-up) is a type of esophagectomy, an upper gastrointestinal tract operation performed for mid and distal esophageal pathology, usually esophageal cancer.

Due to the necessity of removing a significant length of the esophagus, the stomach is "pulled up" into the thoracic cavity. The resulting appearances can be striking on chest x-ray, with an appearance mimicking achalasia.

laparotomy
- stomach and esophagus mobilized
- "gastric tube" may be formed
- abdominal lymphadenectomy
- possible pyloroplasty/pyloromyotomy (not practised by all surgeons)
right thoracotomy
- esophagus and adjacent tissue removed en bloc
- mediastinal lymphadenectomy
- stomach (or gastric tube) pulled into the chest and anastomosed with the more proximal esophagus

The conduit is usually paravertebral but may be substernal or right paratracheal.

Potential advantages over the McKeown procedure are lower rates of stricture, leak, recurrent laryngeal nerve palsy, and aspiration ².

Radiographic features

Plain radiograph

tubular paramediastinal structure
- extending from cardiophrenic angle to thoracic inlet
- may have air-fluid level
evidence of right-sided thoracotomy
- rib deformity
- suture material or mediastinal surgical clips
absent stomach bubble

History and etymology

The distinguished Welsh surgeon Ivor Lewis (1895-1982) first described his procedure in the Hunterian Oration at the Royal College of Surgeons in 1946 ^3,5.

Differential diagnosis

The imaging differential diagnosis includes:

References

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