Clinical observation on perioperative complications of minimally invasive Ivor-Lewis and minimally invasive McKeown esophagectomy / 中华肿瘤杂志

Objective: To compare and analyze the perioperative clinical effects of minimally invasive Ivor-Lewis esophagectomy (MIE-Ivor-Lewis) and minimally invasive McKeown esophagectomy (MIE-McKeown). Methods: A total of 147 patients who underwent endoscopic esophageal cancer surgery from April 2018 to August 2019 were selected, including 85 patients undergoing MIE-McKeown surgery and 62 patients undergoing MIE-Ivor-Lewis surgery. The measurement data were expressed as (x±s), the comparison of normally distributed measurement data was performed by independent sample t-test, and the comparison of count data was performed by χ(2) test or Fisher's exact test. Results: The operation time of McKeown (M) group and Ivor-Lewis (IL) group were (219.2±72.4) minutes and (225.8±65.3) minutes. The mediastinal lymph node dissection number of M and IL groups were 13.3±4.8 and 11.6±6.5, respectively. The number of left recurrent laryngeal nerve lymph node dissection were 3.5±1.2 and 3.1±1.4, respectively. The intraoperative blood loss were (178.3±41.3) ml and (163.2±64.1) ml, respectively. The number of patients reoperated for postoperative bleeding were 1 and 0, respectively. The number of patients with postoperative gastric bleeding were 0 and 1, respectively. The postoperative chest tube retention time were (2.8±1.3) days and (3.1±1.2) days, respectively. The number of patients with anastomotic leakage were 7 and 1, respectively. The number of patients with lung infection were 13 and 5, respectively, and with chylothorax were 2 and 1, respectively, without statistically significant difference (P>0.05). The number of patients with hoarseness were 11 and 3, respectively. The total incidence of complication were 41.2% (35/85) and 17.7% (11/62), and the postoperative hospital stay were (14.7±6.5) days and (12.3±2.3) days, with statistical difference (P<0.05). Conclusion: MIE-Ivor-Lewis and MIE-McKeown are safe and effective in treating esophageal cancer, but the complication of MIE-Ivor-Lewis is less than that of MIE-Mckeown, and the perioperative clinical effect of MIE-Ivor-Lewis is better than that of MIE-McKeown.

Clinical analysis of minimally invasive McKeown esophagectomy in a single center by a single medical group / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

OBJECTIVE@#McKeown esophagectomy followed by cervical and abdominal procedures has been commonly used for invasive esophageal carcinoma. This minimally-invasive operative procedure in the lateral prone position has been considered to be the most appropriate method. We describe our experiences in minimally invasive McKeown esophagectomy (MIME) for esophageal cancer.@*METHODS@#Between March 2016 and February 2018, a total of 82 patients underwent MIME by a single group in our department (a single center). All procedure, operation, oncology, and complication data were reviewed.@*RESULTS@#All MIME procedures were completed successfully, with no conversions to open surgery. The median operative time was 260 min, and median blood loss was 100 ml. The average number of total harvested lymph nodes was 20.1 in the chest and 13.5 in the abdomen. There were no deaths within 30 postoperative days. Twenty cases (24.4%) developed postoperative complications, including anastomotic leak in 4 (4.9%), single lateral recurrent nerve palsy in 4 (4.9%), bilateral recurrent nerve palsy in 1 (1.2%), pulmonary problems in 3 (3.7%), chyle leak in 1 (1.2%), and other complications in 7 (including pleural effusions in 4, incomplete ileus in 2, and neck incision infection in 1; 8.54%). Average postoperative hospitalization time was 12 d. Blood loss, operation time, morbidity rate, and the number of harvested lymph nodes were analyzed by evaluating learning curves in different periods. Significant differences were found in operative time (P=0.006), postoperative hospitalization days (P=0.015), total harvested lymph nodes (P=0.003), harvested thoracic lymph nodes (P=0.006), and harvested abdominal lymph nodes (P=0.022) among different periods.@*CONCLUSIONS@#Surgical outcomes following MIME for esophageal cancer are safe and acceptable. The MIME procedure for stages I and II could be performed proficiently and reached an experience plateau after approximately 25 cases.

Comparison of endoscopic and open McKeown esophagectomy / 肿瘤研究与临床

Objective To evaluate the feasibility of endooscopic minimally invasive McKeown esophagectomy in the treatment of esophageal carcinoma. Methods From June 2012 to August 2015, the data of 180 patients with esophageal carcinoma was retrospectively analyzed. The patients were divided into endoscopy McKeown esophagectomy group (EME group) and open McKeown esophagectomy group (OME group), each group had 90 patients. The clinical pathological data, perioperative data and postoperative complications between the two groups were analyzed. Results The operation time in EME group was longer than that in OME group [(289 ± 30) min vs. (252 ± 28) min, t= 8.063, P 0.05). Conclusions Endoscopic minimally invasive McKeown esophagectomy has the same effect as open surgery, and trauma is small. Therefore, for the patients who are suitable for the minimally invasive surgery, it can be preferred.

Comparison of short-term outcomes between minimally invasive McKeown esophagectomy and Ivor-Lewis esophagectomy for esophageal cancer / 中南大学学报(医学版)

Objective:To summarize the outcomes of 74 patients with minimally invasive McKeown esophagectomy (MIE-McKeown),and to discuss the short-term outcomes by comparing with IvorLewis esophagectomy (ILE) procedure.Methods:A total of 74 patients with esophageal carcinoma underwent MIE-McKeown in Xiangya Hospital from November 2014 to July 2016 were retrospectively reviewed,and 85 patients underwent ILE procedure were selected as a control group.Perioperative and short-term outcomes were analyzed.Results:Compared with the ILE group,patients underwent MIE-McKeown had less blood loss,less pulmonary infection,longer resection length and more harvested lymph nodes (P＜0.05),but they had more anastomotic leakage and stricture rate,longer operation time and hospital stay as well (P＜0.05).The total rate of lymph node metastatic in all patients was 52.8％,and the rate of cervical lymph node metastases was 9.5％ in the MIE-McKeown group.Multiple carcinomas were found in 16 cases,and 7 were proximally located.The distance from the distal margin of the second lesion to the center of the main lesion was 20-85 (50.7±23.0) mm,while the distance in 9 second carcinomas distally located was 30-90 (57.8±20.5) mm.Conclusion:Compared with Ivor-Lewis esophagectomy procedure,MIE-McKeown procedure has a more complete lesion dissection and more harvested lymph nodes with smaller incisions,better short-term outcomes and more safety.It is an appropriate procedure for esophagectomy.However,it should be optimized for its high rate of anastomotic leakage and stricture.