Short-term outcomes of minimal invasive esophagectomy for cancer: Ivor-Lewis versus McKeown

Objective To compare the short-term outcomes of minimal invasive Ivor-Lewis esophagectomy and McKeown esophagectomy in the treatment of esophageal cancer. Methods Clinical data about patients with esophageal cancer who had undergone minimal invasive esophagectomy (MIE) in the department of thoracic surgery of Chinese PLA General Hospital from November 2014 to May 2016 were collected and analyzed. Baseline characteristics were compared for comparability assessment and intra- and post-operative outcomes were analyzed for comparison of minimal invasive Ivor-Lewis esophagectomy and McKeown esophagectomy. Results Totally 120 patients underwent minimal invasive Ivor-Lewis and 65 patients with minimal invasive McKeown. No significant difference was found in baseline data between two groups of patients except tumor location. There was no significant difference between two groups in terms of intra-operative blood loss, rate of transition to thoracotomy or laparotomy, operating time, hospital stay, postoperative pain index and number of resected lymph nodes. The operating time of Ivor - Lewis group was a bit longer than that of McKeown group (314±450 min vs (303±37) min, but the difference was not significant. The incidences of anastomotic fistula and laryngeal recurrent nerve injury were significantly lower in the Ivor-Lewis group than those in the McKeown group 2.5% vs 12.3% (P=0.02), 0.8% vs 9.2% (P=0.04), while there was no significant difference in terms of other complications including pulmonary complications, chylothorax, delayed gastric emptying and cardiac arrhythmia. One hundred and eighty (97.3%) patients were followed up with median follow-up of (8.4±6.8) months (ranging from 1 to 18 months). No statistically significant difference was found in acid reflux, difficulties in swallowing, emptying dysfunction, chest discomfort between patients in two groups during follow-up. Conclusion This study indicates that, though minimally invasive McKeown esophagectomy has a natural advantage of complete resection, Ivor - Lewis surgery has a lower incidence of anastomotic fistula and laryngeal recurrent nerve paralysis. For patients with esophageal cancer located in the middle and the lower part, it still needs to be further studied to assess whether McKeown is the best choice.