Esofagectomía mínimamente invasiva según técnica de Ivor-Lewis. Técnica quirúrgica paso a paso

Esofagectomía mínimamente invasiva según técnica de Ivor-Lewis. Técnica quirúrgica paso a paso

Step-by-Step Surgical Technique for Minimally Invasive Ivor-Lewis Esophagectomy

Clara Fernández Fernández*, Cristina Alegre Torrado*, Javier Martínez Caballero*, Elías Rodríguez Cuéllar*

* Unidad de Cirugía Esofagogástrica y Bariátrica. Servicio de Cirugía General y Aparato Digestivo.
     Hospital Universitario 12 de Octubre, Madrid, España.

DOI: https://doi.org/10.14679/5182

Resumen:

La esofagectomía de Ivor-Lewis constituye un abordaje quirúrgico para el cáncer de esófago distal y de la unión esofagogástrica. Se describe la técnica mínimamente invasiva que se desarrolla en dos etapas. En la fase abdominal (laparoscópica) se moviliza el estómago preservando la arteria gastroepiploica derecha para realizar la gastroplastia tipo Akiyama y se lleva a cabo la linfadenectomía del tronco celiaco, vasos gástricos izquierdos, la arteria hepática común y de la esplénica proximal. En la fase torácica (toracoscópica), tras recolocar al paciente en decúbito prono se moviliza el esófago torácico y se realiza la linfadenectomía mediastínica, para finalmente confeccionar una anastomosis esofagogástrica intratorácica. Aunque ambas técnicas tienen una mortalidad similar a los 12 meses, la técnica de Ivor-Lewis presenta ventajas frente a la de McKeown: menor incidencia de fuga anastomótica (aunque asociada a mayor tasa de reintervención) y de estenosis, reducción de las complicaciones pulmonares y menor tasa de quilotórax.
Palabras Clave: esofagectomía toracoscópica, cáncer de esófago, técnica de Ivor-Lewis, cirugía mínimamente invasiva.

Abstract:

Ivor-Lewis esophagectomy constitutes the surgical approach of choice for resectable distal esophageal and esophagogastric junction cancer. Minimally invasive technique is described, performed in two stages. During the abdominal phase (laparoscopic), the stomach is mobilized while preserving the right gastroepiploic artery to perform the Akiyama type gastroplasty, followed by lymphadenectomy of the celiac trunk. In the thoracic phase (thoracoscopic), after repositioning the patient in the prone position, the thoracic esophagus is mobilized and a mediastinal lymphadenectomy is performed, culminating in an intrathoracic esophagogastric anastomosis. Although both techniques show similar 12-month mortality rates, the Ivor-Lewis approach offers advantages over the McKeown technique: a lower incidence of anastomotic leak (though associated with a higher reintervention rate) and stenosis, a reduction in pulmonary complications, and a lower rate of chylothorax.
Key words: Thoracoscopic esophagectomy, esophageal cancer, Ivor-Lewis technique, minimally invasive surgery.

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