Short-term efficacy and safety of McKeown and Sweet operation in the treatment of esophageal cancer: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHENG Tao ^1,2 , WU Xusheng ^1,2 , HONG Ziqiang ^1,2 , LI Hongchao ^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：

McKeown; Sweet; esophageal neoplasm; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202305050

Video：

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Objective To systematically evaluate the short-term efficacy and safety of McKeown and Sweet methods in the treatment of esophageal cancer. Methods PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang, VIP, CNKI and China General Library of Biomedical Literature were searched for literature on the short-term efficacy and safety of McKeown and Sweet methods in the treatment of esophageal cancer published from the establishment to May 2023. Newcastle-Ottawa Scale was used to evaluate the quality of researches, and meta-analysis was performed using RevMan5.4. Results A total of 9 articles were included, involving 3687 patients including 1019 in the McKeown group and 2668 in the Sweet group. NOS score was 8-9 points. There were no statistical differences in the age, sex or American Joint Committee on Cancer stage between the two groups (P>0.05). Patients in the McKeown group had longer operative time and hospital stay, more intraoperative blood loss, and higher Eastern Cooperative Oncology Group scores than those in the Sweet group (P<0.05). However, the McKeown operation could remove more lymph nodes. In terms of safety, the incidences of pulmonary complications [OR=2.20, 95%CI (1.40, 3.46), P＜0.001] and postoperative anastomotic leakage [OR=2.06, 95%CI (1.45, 2.92), P＜0.001] were higher in the McKeown group than those in the Sweet group. In addition, there were no statistical differences between the two groups in the Karnofsky score, cardiac complications, vocal cord injury or paralysis, chylous leakage, or gastric emptying (P>0.05). Conclusion Compared with McKeown, Sweet method has advantages in operation time, intraoperative blood loss and hospital stay, and had lower incidence of postoperative pulmonary complications and anastomotic leakage. However, McKeown has more lymph node dissection.

1.	Morgan E, Soerjomataram I, Rumgay H, et al. The global landscape of esophageal squamous cell carcinoma and esophageal adenocarcinoma incidence and mortality in 2020 and projections to 2040: New estimates from GLOBOCAN 2020. Gastroenterology, 2022, 163(3): 649-658.
2.	Feng R, Su Q, Huang X, et al. Cancer situation in China: What does the China cancer map indicate from the first national death survey to the latest cancer registration? Cancer Commun (Lond), 2023, 43(1): 75-86.
3.	黄大新, 韩松辰, 金大成等. 奈达铂对比顺铂联合氟尿嘧啶治疗食管癌疗效和安全性的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2022, 29(11): 1511-1516.
4.	Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin, 2020, 70(1): 7-30.
5.	Li B, Zhang Y, Miao L, et al. Esophagectomy with three-field versus two-field lymphadenectomy for middle and lower thoracic esophageal cancer: Long-term outcomes of a randomized clinical trial. J Thorac Oncol, 2021, 16(2): 310-317.
6.	Mansour AI, Reddy RM. Improving oncologic outcomes for esophageal cancer after open and minimally invasive esophagectomy. Ann Surg Oncol, 2022, 29(9): 5369-5371.
7.	Li B, Hu H, Zhang Y, et al. Extended right thoracic approach compared with limited left thoracic approach for patients with middle and lower esophageal squamous cell carcinoma: Three-year survival of a prospective, randomized, open-label trial. Ann Surg, 2018, 267(5): 826-832.
8.	杨刚华, 张雷, 王林, 等. Ivor-Lewis术式与Sweet术式治疗胸段食管癌的疗效比较. 现代肿瘤医学, 2021, 29(24): 4328-4332.
9.	Yang D, Mao YS, He J, et al. Long-term survival of the middle and lower thoracic esophageal cancer patients after surgical treatment through left or right thoracic approach. J Thorac Dis, 2018, 10(5): 2648-2655.
10.	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.
11.	Feng Y, Wu N, Yan S, et al. Comparison of Ivor Lewis esophagectomy and Sweet esophagectomy for the treatment of middle-lower esophageal squamous cell carcinoma. J Thorac Dis, 2019, 11(8): 3584-3592.
12.	Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Hospital Research Institute, 2014. Available from:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. [Accessed on 2017-08-15.
13.	梁海峰. Swee、Ivor-Lewis及McKeown手术治疗中下段食管癌的临床研究. 现代中西医结合杂志, 2014, 23(27): 3016-3018,3058.
14.	付强, 夏志清. 六种不同的食管癌根治性手术的远期预后及近期恢复情况比较. 现代消化及介入诊疗, 2020, 25(6): 775-779.
15.	胡红军, 张立国, 王振华, 等. 食管癌患者不同手术方案术后并发症的对比研究. 实用癌症杂志, 2014(4): 435-438.
16.	韩莉. 行不同术式的食管癌患者生存分析、术中术后并发症及生存质量的回顾性研究. 河北医科大学, 2016.
17.	刘楠. 各种食管癌术式的特点及发展过程分析. 吉林大学, 2019.
18.	丁清清, 薛磊, 周文颖, 等. 老年食管癌患者不同术式的选择和术后并发症比较. 中华老年医学杂志, 2019, 38(3): 292-295.
19.	宋宇, 张真铭, 陈龙奇, 等. 腔镜与开胸食管癌切除术围术期并发症的比较. 中华胸心血管外科杂志, 2013, 29(6): 346-348.
20.	Zheng Y, Li Y, Liu X, et al. Right compared with left thoracic approach esophagectomy for patients with middle esophageal squamous cell carcinoma. Front Oncol, 2020, 10: 536842.
21.	Chen D, Hu Y, Chen Y, et al. Comparison of outcomes between McKeown and Sweet esophagectomy in the elderly patients for esophageal squamous cell carcinoma: A propensity score-matched analysis. Cancer Control, 2020, 27(1): 1073274820904700.
22.	Parkin DM, Pisani P, Ferlay J. Global cancer statistics. CA Cancer J Clin, 1999, 49(1): 33-64.
23.	Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
24.	Wang H, Xu Y, Zuo F, et al. Immune-based combination therapy for esophageal cancer. Front Immunol, 2022, 13: 1020290.
25.	Rai V, Abdo J, Agrawal DK. Biomarkers for early detection, prognosis, and therapeutics of esophageal cancers. Int J Mol Sci, 2023, 24(4): 3316.
26.	Sun YX, Zhu TY, Wang GJ, et al. Thoracolaparoscopic radical esophagectomy for esophageal cancer based on the mesoesophageal theory. Sci Rep, 2023, 13(1): 8760.
27.	方云昊, 陈子豪, 韦荣强, 等. 充气纵隔镜与电视胸腔镜联合腹腔镜手术治疗食管癌的短期随访结果比较. 中国胸心血管外科临床杂志, 2021, 28(2): 239-242.
28.	McKeown KC. Total three-stage oesophagectomy for cancer of the oesophagus. Br J Surg, 1976, 63(4): 259-262.
29.	Churchill ED, Sweet RH. Transthoracic resection of tumors of the esophagus and stomach. Ann Surg, 1942, 115(6): 897-920.
30.	Zhang H, Wang J, Wang W, et al. A meta-analysis of esophagectomy: The comparative study of Ivor-Lewis operation and Sweet operation. Zhonghua Wei Chang Wai Ke Za Zhi, 2014, 17(9): 892-897.
31.	Mu JW, Gao SG, Xue Q, et al. The impact of operative approaches on outcomes of middle and lower third esophageal squamous cell carcinoma. J Thorac Dis, 2016, 8(12): 3588-3595.

1. Morgan E, Soerjomataram I, Rumgay H, et al. The global landscape of esophageal squamous cell carcinoma and esophageal adenocarcinoma incidence and mortality in 2020 and projections to 2040: New estimates from GLOBOCAN 2020. Gastroenterology, 2022, 163(3): 649-658.
2. Feng R, Su Q, Huang X, et al. Cancer situation in China: What does the China cancer map indicate from the first national death survey to the latest cancer registration? Cancer Commun (Lond), 2023, 43(1): 75-86.
3. 黄大新, 韩松辰, 金大成等. 奈达铂对比顺铂联合氟尿嘧啶治疗食管癌疗效和安全性的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2022, 29(11): 1511-1516.
4. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin, 2020, 70(1): 7-30.
5. Li B, Zhang Y, Miao L, et al. Esophagectomy with three-field versus two-field lymphadenectomy for middle and lower thoracic esophageal cancer: Long-term outcomes of a randomized clinical trial. J Thorac Oncol, 2021, 16(2): 310-317.
6. Mansour AI, Reddy RM. Improving oncologic outcomes for esophageal cancer after open and minimally invasive esophagectomy. Ann Surg Oncol, 2022, 29(9): 5369-5371.
7. Li B, Hu H, Zhang Y, et al. Extended right thoracic approach compared with limited left thoracic approach for patients with middle and lower esophageal squamous cell carcinoma: Three-year survival of a prospective, randomized, open-label trial. Ann Surg, 2018, 267(5): 826-832.
8. 杨刚华, 张雷, 王林, 等. Ivor-Lewis术式与Sweet术式治疗胸段食管癌的疗效比较. 现代肿瘤医学, 2021, 29(24): 4328-4332.
9. Yang D, Mao YS, He J, et al. Long-term survival of the middle and lower thoracic esophageal cancer patients after surgical treatment through left or right thoracic approach. J Thorac Dis, 2018, 10(5): 2648-2655.
10. 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.
11. Feng Y, Wu N, Yan S, et al. Comparison of Ivor Lewis esophagectomy and Sweet esophagectomy for the treatment of middle-lower esophageal squamous cell carcinoma. J Thorac Dis, 2019, 11(8): 3584-3592.
12. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Hospital Research Institute, 2014. Available from:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. [Accessed on 2017-08-15.
13. 梁海峰. Swee、Ivor-Lewis及McKeown手术治疗中下段食管癌的临床研究. 现代中西医结合杂志, 2014, 23(27): 3016-3018,3058.
14. 付强, 夏志清. 六种不同的食管癌根治性手术的远期预后及近期恢复情况比较. 现代消化及介入诊疗, 2020, 25(6): 775-779.
15. 胡红军, 张立国, 王振华, 等. 食管癌患者不同手术方案术后并发症的对比研究. 实用癌症杂志, 2014(4): 435-438.
16. 韩莉. 行不同术式的食管癌患者生存分析、术中术后并发症及生存质量的回顾性研究. 河北医科大学, 2016.
17. 刘楠. 各种食管癌术式的特点及发展过程分析. 吉林大学, 2019.
18. 丁清清, 薛磊, 周文颖, 等. 老年食管癌患者不同术式的选择和术后并发症比较. 中华老年医学杂志, 2019, 38(3): 292-295.
19. 宋宇, 张真铭, 陈龙奇, 等. 腔镜与开胸食管癌切除术围术期并发症的比较. 中华胸心血管外科杂志, 2013, 29(6): 346-348.
20. Zheng Y, Li Y, Liu X, et al. Right compared with left thoracic approach esophagectomy for patients with middle esophageal squamous cell carcinoma. Front Oncol, 2020, 10: 536842.
21. Chen D, Hu Y, Chen Y, et al. Comparison of outcomes between McKeown and Sweet esophagectomy in the elderly patients for esophageal squamous cell carcinoma: A propensity score-matched analysis. Cancer Control, 2020, 27(1): 1073274820904700.
22. Parkin DM, Pisani P, Ferlay J. Global cancer statistics. CA Cancer J Clin, 1999, 49(1): 33-64.
23. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
24. Wang H, Xu Y, Zuo F, et al. Immune-based combination therapy for esophageal cancer. Front Immunol, 2022, 13: 1020290.
25. Rai V, Abdo J, Agrawal DK. Biomarkers for early detection, prognosis, and therapeutics of esophageal cancers. Int J Mol Sci, 2023, 24(4): 3316.
26. Sun YX, Zhu TY, Wang GJ, et al. Thoracolaparoscopic radical esophagectomy for esophageal cancer based on the mesoesophageal theory. Sci Rep, 2023, 13(1): 8760.
27. 方云昊, 陈子豪, 韦荣强, 等. 充气纵隔镜与电视胸腔镜联合腹腔镜手术治疗食管癌的短期随访结果比较. 中国胸心血管外科临床杂志, 2021, 28(2): 239-242.
28. McKeown KC. Total three-stage oesophagectomy for cancer of the oesophagus. Br J Surg, 1976, 63(4): 259-262.
29. Churchill ED, Sweet RH. Transthoracic resection of tumors of the esophagus and stomach. Ann Surg, 1942, 115(6): 897-920.
30. Zhang H, Wang J, Wang W, et al. A meta-analysis of esophagectomy: The comparative study of Ivor-Lewis operation and Sweet operation. Zhonghua Wei Chang Wai Ke Za Zhi, 2014, 17(9): 892-897.
31. Mu JW, Gao SG, Xue Q, et al. The impact of operative approaches on outcomes of middle and lower third esophageal squamous cell carcinoma. J Thorac Dis, 2016, 8(12): 3588-3595.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesShort-term efficacy and safety of McKeown and Sweet operation in the treatment of esophageal cancer: A systematic review and meta-analysis

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