Short-term Outcomes of Minimally Invasive McKeown Procedure Versus Open Ivor-Lewis Procedure for Lower and Middle Esophageal Cancer

Abstract

Objective: To compare the short-term efficacy of treating lower and middle esophageal cancer by thoracolaparoscopic minimally invasive McKeown radical esophagectomy with open Ivor-Lewis esophagectomy. Methods: Fifty-four patients with middle and lower esophageal cancer admitted to the Department of Thoracic Surgery and Department of Surgical Oncology of our hospital from January 2013 to December 2017 were reviewed, and were divided into 16 cases in the observation group, which underwent thoracolaparoscopic minimally invasive McKeown esophageal cancer radical operation, and 38 cases in the control group, which underwent open thoracic Ivor-Lewis esophageal cancer radical operation, according to different surgical methods. The perioperative indicators, postoperative complications, and quality of life scores of the two groups were compared. Results: Intraoperative bleeding, postoperative chest drainage, extubation time, venting time, and hospitalization time of the observation group were lower than those of the control group (P<0.05); and the number of cleared lymph nodes of the observation group was more than that of the control group (P<0.05). Comparing the VAS pain scores of the two groups on the 1st, 2nd and 3rd days of postoperative activity, the VAS score of the observation group was lower than that of the control group (P<0.05). Comparison of leukocyte count and C-reactive protein on the 1st and 7th postoperative days between the two groups, the observation group was lower than the control group (P<0.05). There were differences in the observation group in the occurrence of reflux gastritis, lung infection, anastomotic fistula, abnormal skin sensation and hoarseness compared with the control group (P<0.05). Comparing the quality of life scores of the two groups at 1 month after surgery, there was a difference between the observation group in somatic, role, emotional, and general function scores were better than the control group (P<0.05), while there was no statistical significance in cognitive and social function scores (P>0.05). Conclusion: Minimally invasive McKeown's procedure and open Ivor-Lewis's procedure can both be used as surgical procedures for the treatment of lower and middle esophageal cancer, Ivor-Lewis's procedure has a lower incidence of anastomotic fistula and laryngeal recurrent nerve paralysis, and is highly traumatizing; minimally invasive McKeown's procedure clears a larger number of lymph nodes, has a positive efficacy, is less traumatizing, has a quicker recovery, and has better short-term results.