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Last updated: 15-Oct-2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Robotic Cancer Surgeon (GI)
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad · 18 years of experience
★★★★★ Google: 4.9 from 53 reviews (Gota clinic) · 5.0 from 25 reviews (Apollo, Bhat)
In short
Ivor Lewis is a two-stage operation for food pipe cancer. The surgeon works first in the belly, then in the right side of the chest.
It fits cancers of the lower food pipe and some cancers where the food pipe meets the stomach, usually after chemotherapy or chemoradiation.
The plan holds only if the cancer can be cleared below a vein called the azygos, and the new tube reaches there with a good blood supply.
An oesophagectomy removes the cancer-bearing part of the food pipe. The stomach is then shaped into a narrow tube and lifted up to replace it. Surgeons name the operation by where the cuts go and where the new join is made.
In an Ivor Lewis operation, there are two stages. The belly stage frees the stomach and its lymph nodes. The chest stage, through the right side, removes the food pipe and its nodes. The join is made high in the chest, at the level of the azygos vein. This vein arches over the right airway, and it marks the top of the chest work.
| Operation | Where the work is done | Where the new join sits |
|---|---|---|
| Ivor Lewis | Belly and right chest. | High in the chest, at the azygos vein. |
| McKeown | Right chest, belly and neck. | In the neck. |
| Transhiatal | Belly and neck, with no chest opening. | In the neck. |
The question behind every Ivor Lewis plan is simple. Can the cancer be removed with a clear edge, while the join stays below the azygos vein?
Most of these patients first receive chemoradiation or chemotherapy. The type of cancer decides which one. The operation follows once that course is complete.
Two groups are steered to another operation. A cancer reaching up to or above the azygos vein needs a join in the neck, so a McKeown operation is planned. A junction cancer that sits mainly in the stomach, Siewert type III, is treated with a stomach-led operation instead.
Before surgery, the plan is tested against your scans, your lungs, your heart and your nutrition. Any weak link can change the operation.
| Check | Why it matters for Ivor Lewis |
|---|---|
| The main artery along the stomach’s outer curve, on the CT scan. | It feeds the new food pipe. If it is damaged or blocked, the plan changes. |
| The distance from the cancer to the azygos vein. | Too short a distance means the join must go to the neck. |
| Breathing tests. | One lung is rested during the chest stage. Weak lungs may need a different route. |
| Heart tests. | A major chest operation puts a load on the heart. |
| Weight, protein and muscle. | Poor nutrition makes a leak from the join more likely. |
| Smoking. | It must stop at least eight weeks before surgery. |
| Endoscopic ultrasound and PET scan. | They show depth, nodes and any spread beyond the chest. |
A planned exercise and protein programme of four to six weeks is advised before surgery. It is called prehabilitation, and it lowers lung problems after the operation.
The robot can do both stages. In the belly, four thin arms work across the upper abdomen. In the chest, four arms work along the right side, with the patient lying on the left side. The wristed instruments help most deep in the chest, where the join is stitched and stapled. They also help in a heavy build or a deep chest.
The robot is not the right tool for everyone. An open chest stage is preferred after radiation given as the main treatment, because the tissues are scarred. It is also preferred after earlier right chest surgery, and for a bulky cancer stuck to nearby organs. Some patients have a hybrid plan: keyhole belly stage and open chest stage.
Trials comparing these routes found fewer lung problems with keyhole and robotic surgery than with fully open surgery. Long-term cancer control was the same. Open Ivor Lewis is still a standard and accepted operation.
Near the windpipe, the robotic team uses wristed energy tools instead of rigid hot ones. The console gives no sense of touch, so this care matters.
For the same reason, if the stomach tube does not slide easily into the chest, it is guided up with hand-held keyhole instruments. Robotic graspers are not used to force it.
| When | What usually happens |
|---|---|
| Days 1 to 3 | Care in the ICU. Sitting up, walking and breathing exercises start on day 1. |
| Days 3 to 7 | The chest tube comes out once its drainage is low and clear. |
| Days 5 to 7 | An endoscopy checks the join. If it looks healthy, soft food by mouth begins. |
| Days 7 to 10 | Home, if eating, walking and breathing are on track. |
| Next 4 to 6 weeks | Feeding through the small tube tops up meals until eating is enough. |
Blood thinner injections continue for about four weeks. Small, frequent meals taken sitting upright suit the new food pipe.
These are named in words here. Your own figures are discussed at the consent meeting.
No. It can be done open, by keyhole, as a hybrid, or with the robot. The choice depends on your scans, lungs, earlier treatment and earlier surgery.
When the cancer can be cleared below the azygos vein, a join in the chest avoids a neck cut. The voice nerves are also less exposed.
Yes. If the cut edge shows cancer, or the new tube cannot reach without pull, the join is moved to the neck. This is a McKeown operation.
Most patients do. Squamous cell cancer usually gets chemoradiation first, and adenocarcinoma usually gets chemotherapy before and after surgery.
Soft food starts after the join is checked, around the first week. A small feeding tube tops up meals for four to six weeks.
Food pipe cancer surgery at this centre is covered on the robotic oesophageal cancer surgery page. For questions before you travel, call +91-63590-11009.
Shah’s Gastro, Cancer & Robotic Surgery Centre, Gota, Ahmedabad
Consultation, review of scans and biopsy reports, second opinions and follow-up.
Apollo Hospital, Bhat, Gandhinagar
Admission, robotic and open surgery, and inpatient care.
Told that an Ivor Lewis operation is planned for your food pipe cancer? The endoscopy, biopsy, CT and PET reports can be sent ahead on WhatsApp, so the visit starts with them already read. Whether this operation suits you is decided at the consultation, after examination. Call +91-63590-11009 Send reports before your visit
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