[Comparison of short-term outcomes between minimally invasive McKeown esophagectomy and Ivor-Lewis esophagectomy for esophageal cancer]

Abstract

To summarize the outcomes of 74 patients with minimally invasive McKeown esophagectomy (MIE-McKeown), and to discuss the short-term outcomes by comparing with Ivor-Lewis esophagectomy (ILE) procedure. Methods: A total of 74 patients with esophageal carcinoma underwent MIE-McKeown in Xiangya Hospital from November 2014 to July 2016 were retrospectively reviewed, and 85 patients underwent ILE procedure were selected as a control group. Perioperative and short-term outcomes were analyzed. Results: Compared with the ILE group, patients underwent MIE-McKeown had less blood loss, less pulmonary infection, longer resection length and more harvested lymph nodes (P<0.05), but they had more anastomotic leakage and stricture rate, longer operation time and hospital stay as well (P<0.05). The total rate of lymph node metastatic in all patients was 52.8%, and the rate of cervical lymph node metastases was 9.5% in the MIE-McKeown group. Multiple carcinomas were found in 16 cases, and 7 were proximally located. The distance from the distal margin of the second lesion to the center of the main lesion was 20-85 (50.7±23.0) mm, while the distance in 9 second carcinomas distally located was 30-90 (57.8±20.5) mm. Conclusion: Compared with Ivor-Lewis esophagectomy procedure, MIE-McKeown procedure has a more complete lesion dissection and more harvested lymph nodes with smaller incisions, better short-term outcomes and more safety. It is an appropriate procedure for esophagectomy. However, it should be optimized for its high rate of anastomotic leakage and stricture.