Thoracoscopic-laparoscopic Ivor-Lewis surgery vs. McKeown surgery in the treatment of thoracic middle-lower segment esophageal cancer.

PURPOSE: The purpose of this study was to compare the efficacy and safety of thoracoscopic-laparoscopic Ivor-Lewis surgery and McKeown surgery in the treatment of thoracic middle-lower segment esophageal cancer. METHODS: The clinical data of 136 patients with thoracic middle-lower segment esophageal cancer were divided into Ivor-Lewis group (n=68) and McKeown group (n=68). The perioperative indexes and the levels of tumor markers were observed. The patients' long-term survival condition was recorded via follow-up. Finally, the long-term quality of life of patients with a survival time >3 years was compared between the two groups after operation using EORTC QLQ-C30 and EORTC QLQ-OES18. RESULTS: The operation time was significantly shorter in Ivor-Lewis group than that in McKeown group. The hospitalization expenses were obviously higher in Ivor-Lewis group than those in McKeown group. The incidence rate of anastomotic fistula, anastomotic stenosis and pulmonary infection was evidently lower in Ivor-Lewis group than that in McKeown group. Moreover, the levels of serum CYFRA21-1, CA125 and CEA evidently declined in both groups after treatment compared with those before treatment. The follow-up results revealed that the 3-year survival rate was 72.1% and 64.7%, respectively. The analysis results of postoperative 3-year quality of life manifested that no statistically significant difference was observed in each index in QLQ-C30 between the two groups, but the dysphagia and reflux scores in QLQ-EOS18 were remarkably superior in Ivor-Lewis group to those in McKeown group. CONCLUSIONS: In the treatment of thoracic middle-lower segment esophageal cancer, minimally-invasive Ivor-Lewis surgery has shorter operation time, better life quality, and fewer postoperative complications (pulmonary infection, anastomotic fistula and anastomotic stenosis) than minimally-invasive McKeown surgery, while the treatment expenses are higher.