Thoracolaparoscopy Esophagectomy For Thoracic Esophageal Cancer:Short-Term Efficacy Study Between Ivor-Lewis Approach And Mckeown Approach

Objectives:By A comparison of Minimally invasive surgical approach between Ivor-Lewis and McKeown approach, To evaluate short-term efficacy of thoracolaparoscopy esophagectomy and intrathoracic esophagogastric anastomosis(Ivor-Lewis approach) for the treatment of thoracic esophageal cancer.Methods:We retrospectively analyzed clinical data of 113 patients with esophageal cancer who underwent thoracolaparoscopy esophagectomy by one surgical team in Hospital from January 2013 to December 2015. All the 113 patients were divided into two groups according to their different surgical approach, including 53 patients who underwent thoracolaparoscopy esophagectomy and intrathoracic esophagogastric anastomosis (MIE-Ivor-Lewis group), and 60 patients who underwent thoracolaparoscopy esophagectomy and esophagogastric cervicalanastomosis (MIE-McKeown group). Intrathoracic anastomosis includes the purse-string anastomosis and reverse-puncture anastomosis. The general information, dissected lymph node number, postoperative complications, quality of life and survival rates were compared between the two groups.Results:These general information and pathological features were similar between the two operative approaches. The location of the esophageal tumer is the primary difference between the two approaches. Tumer of MIE-McKeown group were mainly located in upper and middle thoracic esophageal, but tumer of MIE-Ivor-Lewis group were mainly located in middle and lower thoracic esophageal. There was no statistical differences between two groups in the number of resected lymph nodes, blood loss, postoperative time for dieting, time for thoracic and mediastinum tube, postoperative hospital stays, thoracic and mediastinum drainage. The operation time of MIE-Ivor-Lewis group was significantly longer than that of MIE-McKeown group(302.1±22.9min VS 244.7±22.1min, P=0.000); hospital cost of MIE-Ivor-Lewis group were significantly more than that of MIE-Mc Keown group(8122.8±910.4 VS 7169.8±1204.9, P=0.000). There was no statistical differences between two groups in postoperative complications(15.1% VS 26.7%, p=0.133), but the rate of anastomotic leak and injury of recurrent laryngeal nerve was significantly more frequent in the MIE-McKeown group(16.7% VS 3.8%, p=0.026; 15.0% VS 3.8%, p=0.045). There was no statistical differences between two groups regard to short-term quality of life, postoperative survival rates, recurrent and metastasis rate.Conclusions:There was no differences between thoracolaparoscopy MIE-Ivor-Lewis and MIE-McKeown esophagectomy in security of operation and the number of resected lymph nodes. Thoracolaparoscopy MIE-Ivor-Lewis esophagectomy is superior to MDE-McKeown esophagectomy in postoperative complications and short-term quality of life, but MIE-Ivor-Lewis esophagectomy take more time for operation and more hospital cost. This study showed that thoracolaparoscopy MIE-Ivor-Lewis and MIE-McKeown esophagectomy is safe, the middle and lower thoracic esophageal cancer is more suitable for MIE-Ivor-Lewis esophagectomy, the upper and middle thoracic esophageal cancer is more suitable for MIE-McKeown esophagectomy.