Transthoracic 2F Esophagectomy (Lewis Procedure)

The combination of a laparotomy and right thoracotomy for resection of cancer of the esophagus was proposed in 1946 at the Royal College of Surgeons' Hunterean Lecture by Ivor Lewis. As originally described, the Ivor Lewis esophagectomy was a two-stage procedure.1 The first stage consisted of a laparotomy and mobilization of the stomach, and the second stage performed 10 to 15 days later was a right thoracotomy, resection of the esophagus, and esophagastric anastomosis. The operation was successful in five of seven patients, which was a tremendous feat for this era. Over time, the combined approach evolved into a single procedure, and the Ivor Lewis esophagectomy continues to be widely used.

The Ivor Lewis esophagectomy is appropriate for tumors of the distal esophagus and gastroesophageal junction. The Ivor Lewis esophagectomy is the choice for T2N0 and T3N0 or lesions following induction therapy located below the carina. Although early T1 tumors and high-grade dysplasia in Barrett's are amenable also to this process.