Efficacy and safety of thoraco-laparoscopy combined with Ivor Lewis procedure versus McKeown procedure in the treatment of esophageal carcinoma: An updated systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HONG Ziqiang ^1,2 , JIN Dacheng ² , BAI Xiangdou ^1,2 , CUI Baiqiang ^1,2 ,  GOU Yunjiu ²

1. The First Clinical Department of Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, P. R. China;
2. Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;

Corresponding?author：

GOU Yunjiu, Email: gouyunjiu@163.com

Keywords：

Esophageal carcinoma; minimally invasive esophagectomy; Ivor Lewis surgery; McKeown surgery; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202202042

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Objective To systematically evaluate the efficacy and safety of thoraco-laparoscopy combined with Ivor Lewis surgery versus thoraco-laparoscopy combined with McKeown surgery in the treatment of esophageal carcinoma. Methods PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang database, VIP database and CNKI were searched by computer for the relevant literature comparing the efficacy and safety of Ivor Lewis surgery and McKeown surgery in the treatment of esophageal carcinoma from inception to January 2022. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of cohort studies, and the Cochrane risk of bias tool was used to evaluate the methodological quality of randomized controlled studies. Review Manager 5.4 software was utilized to perform a meta-analysis of the literature. Results A total of 33 articles were included, which consisted of 26 retrospective cohort studies, 3 prospective cohort studies and 4 randomized controlled trials. There were 11 518 patients in total, including 5 454 patients receiving Ivor Lewis surgery and 6064 patients receiving McKeown surgery. NOS score was≥7 points. Meta-analysis showed that, in comparison to the McKeown surgery, the Ivor Lewis surgery had shorter operative time (MD=–19.61, 95%CI –30.20 to –9.02, P<0.001), shorter postoperative hospital stay (MD=–1.15, 95%CI –1.43 to –0.87, P<0.001), lower mortality rate during hospitalization or 30 days postoperatively (OR=0.37, 95%CI 0.20 to 0.71, P=0.003), and lower incidence of total postoperative complications (OR=0.36, 95%CI 0.27 to 0.49, P<0.001). The McKeown surgery had an advantage in terms of the number of lymph nodes dissected (MD=–1.25, 95%CI –2.03 to –0.47, P=0.002), postoperative extubation time (MD=0.78, 95%CI 0.37 to 1.19, P<0.001) and 6-month postoperative recurrence rate (OR=1.83, 95%CI 1.41 to 2.39, P<0.001). The differences between the two surgeries were not statistically significant in terms of intraoperative bleeding, postoperative 1 year-, 3 year- and 5 year-overall survival (OS), and impaired gastric emptying (P>0.05). Conclusion Compared with McKeown surgery, Ivor Lewis surgery has shorter operative time, shorter postoperative hospital stay, lower mortality rate during hospitalization or 30 days postoperatively and lower incidence of total postoperative complications. However, in terms of the number of lymph nodes dissected, postoperative extubation time and 6-month postoperative recurrence rate, McKeown surgery has advantages. Both surgeries have comparable results in terms of intraoperative bleeding, postoperative 1 year-, 3 year- and 5 year-OS, and impaired gastric emptying.

Citation： HONG Ziqiang, JIN Dacheng, BAI Xiangdou, CUI Baiqiang, GOU Yunjiu. Efficacy and safety of thoraco-laparoscopy combined with Ivor Lewis procedure versus McKeown procedure in the treatment of esophageal carcinoma: An updated systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(12): 1757-1765. doi: 10.7507/1007-4848.202202042 Copy

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2.	Gupta B, Kumar N. Worldwide incidence, mortality and time trends for cancer of the oesophagus. Eur J Cancer Prev, 2017, 26(2): 107-118.
3.	Ajani JA, D'Amico TA, Bentrem DJ, et al. Esophageal and esophagogastric junction cancers, version 2. 2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2019, 17(7): 855-883.
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22.	唐小東. 全腔鏡下Ivor-Lews與McKeown術治療胸中下段食管癌的近期療效對比. 西南國防醫藥, 2016, 26(10): 1173-1175.
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1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2. Gupta B, Kumar N. Worldwide incidence, mortality and time trends for cancer of the oesophagus. Eur J Cancer Prev, 2017, 26(2): 107-118.
3. Ajani JA, D'Amico TA, Bentrem DJ, et al. Esophageal and esophagogastric junction cancers, version 2. 2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2019, 17(7): 855-883.
4. 李印, 秦建軍. 中國臨床腫瘤學會(CSCO)食管癌診治指南2020版外科領域更新要點解讀. 中國胸心血管外科臨床雜志, 2020, 27(8): 857-859.
5. 李峰, 唐忠, 劉堅. 胸、腹腔鏡聯合手術與傳統開放手術治療食管癌的療效比較研究. 腹腔鏡外科雜志, 2017, 22(2): 86-89.
6. 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.
7. 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.
8. Straatman J, van der Wielen N, Nieuwenhuijzen GA, et al. Techniques and short-term outcomes for total minimally invasive Ivor Lewis esophageal resection in distal esophageal and gastroesophageal junction cancers: Pooled data from six European centers. Surg Endosc, 2017, 31(1): 119-126.
9. 左杰斌, 瞿文棟, 周愛明, 等. 胸腹腔鏡聯合IvorLewis術與McKeown術治療胸中下段食管癌近期療效的系統評價與Meta分析. 中國胸心血管外科臨床雜志, 2017, 24(6): 456-462.
10. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
11. Higgins JP, Altman DG, G?tzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
12. Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: Review of over 1000 patients. Ann Surg, 2012, 256(1): 95-103.
13. Hao Z, Zhenya S, Lei W. Esophageal-gastric anastomosis in radical resection of esophageal cancer under thoracoscopy combined with laparoscopy. J Coll Physicians Surg Pak, 2014, 24(10): 754-756.
14. Zhai C, Liu Y, Li W, et al. A comparison of short-term outcomes between Ivor-Lewis and McKeown minimally invasive esophagectomy. J Thorac Dis, 2015, 7(12): 2352-2358.
15. Chen L, Liu X, Wang R, et al. Minimally invasive esophagectomy for esophageal cancer according to the location of the tumor: Experience of 251 patients. Ann Med Surg (Lond), 2017, 17: 54-60.
16. Schmidt HM, Gisbertz SS, Moons J, et al. Defining benchmarks for transthoracic esophagectomy: A multicenter analysis of total minimally invasive esophagectomy in low risk patients. Ann Surg, 2017, 266(5): 814-821.
17. 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.
18. van Workum F, Slaman AE, van Berge Henegouwen MI, et al. Propensity score-matched analysis comparing minimally invasive Ivor Lewis versus minimally invasive Mckeown esophagectomy. Ann Surg, 2020, 271(1): 128-133.
19. Chang T, Hsiao PN, Tsai MY, et al. Perioperative management and outcomes of minimally invasive esophagectomy: Case study of a high-volume tertiary center in Taiwan. J Thorac Dis, 2018, 10(3): 1670-1676.
20. Zhang T, Hou X, Li Y, et al. Effectiveness and safety of minimally invasive Ivor Lewis and McKeown oesophagectomy in Chinese patients with stage ⅠA-ⅢB oesophageal squamous cell cancer: A multicentre, non-interventional and observational study. Interact Cardiovasc Thorac Surg, 2020, 30(6): 812-819.
21. Sabra MJ, Alwatari YA, Wolfe LG, et al. Ivor Lewis vs Mckeown esophagectomy: Analysis of operative outcomes from the ACS NSQIP database. Gen Thorac Cardiovasc Surg, 2020, 68(4): 370-379.
22. 唐小東. 全腔鏡下Ivor-Lews與McKeown術治療胸中下段食管癌的近期療效對比. 西南國防醫藥, 2016, 26(10): 1173-1175.
23. 梅閃閃, 劉繼先, 吳昊, 等. 微創荷包鉗法Ivor-Lewis術與McKeown術治療中下段食管癌的近期療效分析. 重慶醫科大學學報, 2016, 41(1): 89-93.
24. 孟慶江. 微創McKeown與Ivor-Lewis手術治療中下段食管癌臨床分析. 中國醫學創新, 2016, 13(1): 17-20.
25. 侯仕振, 矯文捷. 胸腹腔鏡聯合微創Ivor-Lewis與McKeown手術治療中下段食管癌療效比較分析. 世界最新醫學信息文摘, 2017, 17(12): 3-5.
26. 黃書海. 胸中下段食管癌治療中應用微創Ivor-Lewis術與McKeown術的近期療效分析. 醫學理論與實踐, 2017, 30(21): 3189-3191.
27. 孫勇攀, 梅宏, 許川, 等. 胸腹腔鏡聯合Ivor-Lewis手術治療食管胸中下段癌可行性、安全性及近期療效觀察. 海南醫學, 2017, 28(4): 575-577.
28. 許建寧, 劉國鋒. 胸腹腔鏡Ivor-Lewis術與McKeown術在胸中下段食管癌中的應用效果比較. 中國臨床研究, 2017, 30(9): 1219-1221.
29. 彭雄, 陳云, Juma NA, 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.
30. 侯曉彬, 任志鵬, 楊博, 等. 微創Ivor-Lewis手術與McKeown手術治療食管癌的短期療效比較. 解放軍醫學院學報, 2017, 38(10): 908-911.
31. 張永信. 微創McKeown食管癌根治術與Ivor-Lewis手術治療食管癌的效果分析. 中國冶金工業醫學雜志, 2018, 35(5): 599-600.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy and safety of thoraco-laparoscopy combined with Ivor Lewis procedure versus McKeown procedure in the treatment of esophageal carcinoma: An updated systematic review and meta-analysis

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