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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22.	唐小东. 全腔镜下Ivor-Lews与McKeown术治疗胸中下段食管癌的近期疗效对比. 西南国防医药, 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, 秦建军. 中国临床肿瘤学会(CSCO)食管癌诊治指南2020版外科领域更新要点解读. 中国胸心血管外科临床杂志, 2020, 27(8): 857-859.
5. 李峰, 唐忠, 刘坚. 胸、腹腔镜联合手术与传统开放手术治疗食管癌的疗效比较研究. 腹腔镜外科杂志, 2017, 22(2): 86-89.
6. 郑晓东, 张卫民, 侯建彬, 等. 电视胸腔镜食管癌切除术围术期并发症分析及预防. 中国微创外科杂志, 2019, 19(6): 526-530.
7. 王文凭, 何松林, 杨玉赏, 等. 食管癌微创外科手术的现状与思考. 中国胸心血管外科临床杂志, 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, 瞿文栋, 周爱明, 等. 胸腹腔镜联合IvorLewis术与McKeown术治疗胸中下段食管癌近期疗效的系统评价与Meta分析. 中国胸心血管外科临床杂志, 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, Gøtzsche 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. 唐小东. 全腔镜下Ivor-Lews与McKeown术治疗胸中下段食管癌的近期疗效对比. 西南国防医药, 2016, 26(10): 1173-1175.
23. 梅闪闪, 刘继先, 吴昊, 等. 微创荷包钳法Ivor-Lewis术与McKeown术治疗中下段食管癌的近期疗效分析. 重庆医科大学学报, 2016, 41(1): 89-93.
24. 孟庆江. 微创McKeown与Ivor-Lewis手术治疗中下段食管癌临床分析. 中国医学创新, 2016, 13(1): 17-20.
25. 侯仕振, 矫文捷. 胸腹腔镜联合微创Ivor-Lewis与McKeown手术治疗中下段食管癌疗效比较分析. 世界最新医学信息文摘, 2017, 17(12): 3-5.
26. 黄书海. 胸中下段食管癌治疗中应用微创Ivor-Lewis术与McKeown术的近期疗效分析. 医学理论与实践, 2017, 30(21): 3189-3191.
27. 孙勇攀, 梅宏, 许川, 等. 胸腹腔镜联合Ivor-Lewis手术治疗食管胸中下段癌可行性、安全性及近期疗效观察. 海南医学, 2017, 28(4): 575-577.
28. 许建宁, 刘国锋. 胸腹腔镜Ivor-Lewis术与McKeown术在胸中下段食管癌中的应用效果比较. 中国临床研究, 2017, 30(9): 1219-1221.
29. 彭雄, 陈云, Juma NA, 等. 微创McKeown食管癌根治术与Ivor-Lewis手术治疗食管癌的近期疗效对比. 中南大学学报(医学版), 2017, 42(5): 546-552.
30. 侯晓彬, 任志鹏, 杨博, 等. 微创Ivor-Lewis手术与McKeown手术治疗食管癌的短期疗效比较. 解放军医学院学报, 2017, 38(10): 908-911.
31. 张永信. 微创McKeown食管癌根治术与Ivor-Lewis手术治疗食管癌的效果分析. 中国冶金工业医学杂志, 2018, 35(5): 599-600.
32. 戎保林, 郭明发, 吴显宁, 等. 微创Ivor-Lewis术与微创Mckeown术治疗中段食管癌的效果比较. 中国临床保健杂志, 2018, 21(4): 497-500.
33. 凌发昱, 杨渊, 魏益平, 等. 全腔镜Ivor-Lewis术与McKeown术治疗中下段食管癌效果对比. 山东医药, 2018, 58(5): 45-47.
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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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