Outcomes of minimally invasive esophagectomy for patients with stage T3 tumors located on middle or lower thoracic esophagus: Ivor-Lewis versus McKeown

Objective To compare the outcomes of minimally invasive Ivor-Lewis esophagectomy and McKeown esophagectomy in the treatment of patients with stage T3 tumors located at middle or lower thoracic esophagus. Methods Clinical data about patients with esophageal cancer selected from esophageal cancer database who had undergone minimally invasive esophagectomy (MIE) in the department of thoracic surgery of ten hospitals in China from January 2010 to June 2017 were collected and analyzed.Baseline characteristics including perioperative indicators,postoperative complications,pathological indexes and postoperative survival outcomes were compared between the minimally invasive Ivor-Lewis esophagectomy (MIE-IL) group and the minimally invasive McKeown esophagectomy (MIE-MK) group. Results Totally 338 patients underwent MIE-IL and 622 patients underwent MIE-MK.Most of the patients in the two groups were male (87.0% vs 77.5%,P<0.001),most of the tumors were located at the middle thoracic esophagus (78.7% vs 84.4%,P=0.021),and the main pathological type was squamous cell carcinoma (97.3% vs 98.2%,P=0.659).There were significant differences between the MIE-IL group and the MIE-MK group in terms of operating time (341.2±97.2 min vs 317.8±93.0 min,P<0.001),intra-operative blood loss (489.9±511.24 ml vs 364.3±428.9 ml,P<0.001) and number of resected lymph nodes (14.9±9.23 vs 22.3±11.9,P<0.001).The postoperative hospital stay of the MIE-IL group was a bit shorter than that of MIE-MK group,but the difference was not significant (18.5±11.6 d vs 18.8±12.8 d,P>0.05),The incidences of pneumonia and hydrothorax were significantly lower in the MIE-IL group than those in the MIE-MK group (9.5% vs 20.9%,P<0.001;12.7% vs 18.8%,P=0.016).There was no significant difference in anastomotic leakage (3.8% vs 6.1%) and anastomotic stenosis (0.3% vs 0.3%).The MIE-MK group had significantly higher overall survival rate compared to the MIE-IL group (61.4% vs 38.6%;HR 1.49;95% CI:1.19,1.87;P<0.001). Conclusion Our study shows that both MIE-IL and MIE-MK are safe and feasible in treatment of stage T3 esophageal cancer;however,the incidence of postoperative complications is lower in the MIE-IL group,while MIE-MK may represent preferred surgical technique for improved long-term survival.