Efficacy of jejunostomy combined with Ivor-Lewis or McKeown operation in the treatment of middle and lower esophageal cancer: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Chen , TAO Xia , JIANG Li ,  LI Jun

Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P.R.China;

Corresponding?author：

LI Jun, Email: junlixkyy@163.com

Keywords：

Ivor-Lewis operation; McKeown operation; middle and lower esophageal cancer; efficacy

DOI：

10.7507/1007-4848.202007094

Video：

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Objective To investigate the effect of jejunostomy combined with Ivor-Lewis or McKeown operation on the treatment of middle and lower esophageal cancer.Methods The clinical data of 127 patients with middle and lower esophageal cancer admitted to our hospital from June 2018 to October 2019 were retrospectively analyzed, including 89 males and 38 females, aged 62.82±8.65 years. The patients were divided into an Ivor-Lewis group (IL group, 72 patients) and a McKeown group (MK group, 55 patients) according to surgical methods. Patients in the IL group received jejunostomy combined with Ivor-Lewis operation, and patients in the MK group received jejunostomy combined with McKeown operation. The operation time, postoperative bedside electrical impedance tomography (EIT) parameters, postoperative inflammatory factor levels, postoperative complications and rehabilitation of the two groups were compared.Results The operation time (262.65±49.78 min vs. 303.04±60.13 min), postoperative eating time (10.54±2.22 d vs. 11.47±2.49 d) and postoperative hospital stay (14.78±2.47 d vs.15.72±2.36 d) in the IL group were significantly shorter than those in the MK group (P<0.05). The blood loss (156.13±52.43 mL vs. 158.87±48.47 mL) and the number of lymph node dissection (29.47±8.88 vs. 30.17±9.80) in the IL group were less than those in the MK group, but the differences were not statistically significant (P>0.05). The repeated measurement analysis of variance showed that the time point could significantly affect tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and IL-8 levels (F_{time point}=520.543, 272.379, 147.688, all P<0.05), but the surgical methods and the interactive effect of time point and surgical methods did not affect the levels of TNF-α, IL-6 and IL-8 (P>0.05). Postoperative bedside EIT image parameters were statistically different on the postoperative 1 d, 3 d, 5 d and 7 d between the two groups (P<0.05). Compared with the MK group, the incidences of recurrent laryngeal nerve injury, arrhythmia, pulmonary infection and atelectasis, anastomotic leakage, gastric wall necrosis and stump fistula, secondary thoracotomy and abdominal hemostasis, and intestinal obstruction were lower, but the differences were not statistically different (P>0.05). The recurrence rate of patients in the IL group within 6 months was lower than that in the MK group, but the difference was not statistically significant (8.33% vs. 9.09%, P>0.05).Conclusion Jejunostomy combined with Ivor-Lewis or McKeown surgery have equivalent effects on patients with middle and lower esophageal cancer.

Citation： XU Chen, TAO Xia, JIANG Li, LI Jun. Efficacy of jejunostomy combined with Ivor-Lewis or McKeown operation in the treatment of middle and lower esophageal cancer: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(10): 1216-1221. doi: 10.7507/1007-4848.202007094 Copy

1.	Duan JL, Deng B, Song GH, et al. Application of computer-aided tongue inspection for preliminary screening of esophageal cancer. Chin J Integr Med, 2018, 24(10): 746-751.
2.	鄭曉東, 張衛民, 侯建彬, 等. 電視胸腔鏡食管癌切除術圍術期并發癥分析及預防. 中國微創外科雜志, 2019, 19(6): 526-530.
3.	王文憑, 何松林, 楊玉賞, 等. 食管癌微創外科手術的現狀與思考. 中國胸心血管外科臨床雜志, 2018, 25(4): 338-344.
4.	彭雄, 陳云, Abdillah NJ, 等. 微創McKeown食管癌根治術與Ivor-Lewis手術治療食管癌的近期療效對比. 中南大學學報(醫學版), 2017, 42(5): 546-552.
5.	中國抗癌協會食管癌專業委員會編. 食管癌規范化診療指南. 北京: 中國協和醫科大學出版社, 2013.
6.	Sakai M, Sohda M, Miyazaki T, et al. Association of preoperative nutritional status with prognosis in patients with esophageal cancer undergoing salvage esophagectomy. Anticancer Res, 2018, 38(2): 933-938.
7.	朱珠, 劉晴, 庹吉妤, 等. 柴湖地區食管癌及癌前病變風險評估模型建立. 現代預防醫學, 2019, 46(15): 2701-2704, 2712.
8.	黃志剛. 微創與開放Ivor-Lewis食管切除術治療中下段食管癌的圍手術期預后比較. 山西醫藥雜志, 2019, 48(18): 2240-2244.
9.	薛亞斌, 呂紅博, 瓦熱斯江·依不拉音, 等. 微創McKeown食管鱗癌根治術學習曲線特點及喉返神經旁淋巴結清掃對療效的影響. 中華消化外科雜志, 2018, 17(8): 825-829.
10.	Brown AM, Pucci MJ, Berger AC, et al. A standardized comparison of peri-operative complications after minimally invasive esophagectomy: Ivor Lewis versus McKeown. Surg Endosc, 2018, 32(1): 204-211.
11.	White A, Kucukak S, Lee DN, et al. Ivor Lewis minimally invasive esophagectomy for esophageal cancer: An excellent operation that improves with experience. J Thorac Cardiovasc Surg, 2019, 157(2): 783-789.
12.	Shu W, Li H, Gong H, et al. Evaluation of blood vessel injury, oxidative stress and circulating inflammatory factors in an L-NAME-induced preeclampsia-like rat model. Exp Ther Med, 2018, 16(2): 585-594.
13.	Helminen O, Mrena J, Sihvo E. Securing enteral nutrition with routine feeding jejunostomy after esophagectomy: Lost effort or a life saver? J Thorac Dis, 2019, 11(3): 636-637.
14.	Nakamura Y, Momoki C, Okada G, et al. Preoperative depressive mood of patients with esophageal cancer might delay recovery from operation-related malnutrition. J Clin Med Res, 2019, 11(3): 188-195.
15.	Yang YS, Shang QX, Yuan Y, et al. Comparison of long-term quality of life in patients with esophageal cancer after Ivor-Lewis, Mckeown, or sweet esophagectomy. J Gastrointest Surg, 2019, 23(2): 225-231.
16.	Park SY, Suh JW, Kim DJ, et al. Near-infrared lymphatic mapping of the recurrent laryngeal nerve nodes in T1 esophageal cancer. Ann Thorac Surg, 2018, 105(6): 1613-1620.
17.	Nagao M, Fukuda A, Matsumura T, et al. Pulmonary actinomycosis mimicking a lung metastasis from esophageal cancer: A case report. BMC Pulm Med, 2018, 18(1): 39.
18.	Schizas D, Lazaridis II, Moris D, et al. The role of surgical treatment in isolated organ recurrence of esophageal cancer—A systematic review of the literature. World J Surg Oncol, 2018, 16(1): 55.

1. Duan JL, Deng B, Song GH, et al. Application of computer-aided tongue inspection for preliminary screening of esophageal cancer. Chin J Integr Med, 2018, 24(10): 746-751.
2. 鄭曉東, 張衛民, 侯建彬, 等. 電視胸腔鏡食管癌切除術圍術期并發癥分析及預防. 中國微創外科雜志, 2019, 19(6): 526-530.
3. 王文憑, 何松林, 楊玉賞, 等. 食管癌微創外科手術的現狀與思考. 中國胸心血管外科臨床雜志, 2018, 25(4): 338-344.
4. 彭雄, 陳云, Abdillah NJ, 等. 微創McKeown食管癌根治術與Ivor-Lewis手術治療食管癌的近期療效對比. 中南大學學報(醫學版), 2017, 42(5): 546-552.
5. 中國抗癌協會食管癌專業委員會編. 食管癌規范化診療指南. 北京: 中國協和醫科大學出版社, 2013.
6. Sakai M, Sohda M, Miyazaki T, et al. Association of preoperative nutritional status with prognosis in patients with esophageal cancer undergoing salvage esophagectomy. Anticancer Res, 2018, 38(2): 933-938.
7. 朱珠, 劉晴, 庹吉妤, 等. 柴湖地區食管癌及癌前病變風險評估模型建立. 現代預防醫學, 2019, 46(15): 2701-2704, 2712.
8. 黃志剛. 微創與開放Ivor-Lewis食管切除術治療中下段食管癌的圍手術期預后比較. 山西醫藥雜志, 2019, 48(18): 2240-2244.
9. 薛亞斌, 呂紅博, 瓦熱斯江·依不拉音, 等. 微創McKeown食管鱗癌根治術學習曲線特點及喉返神經旁淋巴結清掃對療效的影響. 中華消化外科雜志, 2018, 17(8): 825-829.
10. Brown AM, Pucci MJ, Berger AC, et al. A standardized comparison of peri-operative complications after minimally invasive esophagectomy: Ivor Lewis versus McKeown. Surg Endosc, 2018, 32(1): 204-211.
11. White A, Kucukak S, Lee DN, et al. Ivor Lewis minimally invasive esophagectomy for esophageal cancer: An excellent operation that improves with experience. J Thorac Cardiovasc Surg, 2019, 157(2): 783-789.
12. Shu W, Li H, Gong H, et al. Evaluation of blood vessel injury, oxidative stress and circulating inflammatory factors in an L-NAME-induced preeclampsia-like rat model. Exp Ther Med, 2018, 16(2): 585-594.
13. Helminen O, Mrena J, Sihvo E. Securing enteral nutrition with routine feeding jejunostomy after esophagectomy: Lost effort or a life saver? J Thorac Dis, 2019, 11(3): 636-637.
14. Nakamura Y, Momoki C, Okada G, et al. Preoperative depressive mood of patients with esophageal cancer might delay recovery from operation-related malnutrition. J Clin Med Res, 2019, 11(3): 188-195.
15. Yang YS, Shang QX, Yuan Y, et al. Comparison of long-term quality of life in patients with esophageal cancer after Ivor-Lewis, Mckeown, or sweet esophagectomy. J Gastrointest Surg, 2019, 23(2): 225-231.
16. Park SY, Suh JW, Kim DJ, et al. Near-infrared lymphatic mapping of the recurrent laryngeal nerve nodes in T1 esophageal cancer. Ann Thorac Surg, 2018, 105(6): 1613-1620.
17. Nagao M, Fukuda A, Matsumura T, et al. Pulmonary actinomycosis mimicking a lung metastasis from esophageal cancer: A case report. BMC Pulm Med, 2018, 18(1): 39.
18. Schizas D, Lazaridis II, Moris D, et al. The role of surgical treatment in isolated organ recurrence of esophageal cancer—A systematic review of the literature. World J Surg Oncol, 2018, 16(1): 55.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy of jejunostomy combined with Ivor-Lewis or McKeown operation in the treatment of middle and lower esophageal cancer: A retrospective cohort study

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