Comparison of the surgical outcomes of McKeown minimally invasive esophagectomy and Ivor-Lewis esophagectomy for the treatment of middle esophageal cancer: A single-center retrospective study

In China, the esophageal cancer is the most common tumor type, and the main treatment is still surgical treatment. Over the past decade, thoracic laparoscopy combined with esophageal cancer resection and neck anastomosis---McKeown minimally invasive esophagectomy (MIE) has gained interest and known as a minimally invasive surgery for the middle esophageal cancer. However, the safety and operability of McKeown MIE remains to be confirmed clinically. The purpose of this article is to examine the clinical safety and operability of McKeown MIE, and compare the security and outcomes of McKeown MIE and Ivor-Lewis esophagectomy. The clinical data of 312 patients with middle esophageal cancer in Sir Run Run Shaw Hospital from January 2013 to December 2018 were retrospectively analyzed. Among them, 176 patients underwent Ivor-Lewis esophagectomy and 136 patients underwent McKeown MIE. Patients' demographics and perioperative outcomes were comparable between the two groups. There were no significant differences in terms of operative time, postoperative hospital stay, restore fluid diet time, pathology, tumor node metastasis staging between the two groups. In the McKeown MIE group, the intraoperative blood loss was less than that in the Ivor-Lewis group (116.54 ± 80.99 ml vs 152.78 ± 115.35 ml, p = 0.001). The total number of lymph nodes and the number of lymph nodes dissection in bilateral recurrent laryngeal nerves were more than those in the Ivor-Lewis group (30.04 ± 14.08 vs 27.51 ± 11.34, p = 0.039; 5.74 ± 4.27 vs 1.80 ± 2.68, p < 0.001). There were no significant differences in the incidence of complications. The overall survival for the McKeown MIE group was higher than the Ivor-Lewis group (p = 0.013) and no significant difference was found on disease-free survival. McKeown MIE is safe and operational for middle esophageal cancer, which is consistent with the principle of tumor radicalization.