A standardized comparison of peri-operative complications after minimally invasive esophagectomy: Ivor Lewis versus McKeown

Brown, Andrew; Pucci, Michael J.; Berger, Adam C.; Tatarian, Talar; Evans, Nathaniel R.; Rosato, Ernest L.; Palazzo, Francesco

doi:10.1007/s00464-017-5660-4

Cited by 42 publications

(33 citation statements)

References 28 publications

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“…Luketich et al 9 as well as Brown et al 10 reported an anastomotic leak that needed surgery (CD grade ≥3). These reports suggest that anastomotic leak requires surgical or endoscopic intervention, 29 so we pooled these data and found that the incidence of severe anastomotic leak was not significantly different (OR =1.28, 95% CI =0.73–2.24, P =0.39), as shown in Figure 4 .…”

Section: Resultsmentioning

confidence: 99%

“…Finally, 3,468 patients from 14 cohort studies underwent totally minimally invasive McKeown or Ivor Lewis esophagectomy were subjected to this meta-analysis. 9 , 10 , 17 – 28 No randomized controlled studies or studies adopting hybrid MIE were found. Major characteristics and NOS quality star of the included studies are summarized in Tables 1 and 2 (surgical details and other outcomes can be found in Supplementary materials).…”

Section: Resultsmentioning

confidence: 99%

“…MILE with an intrathoracic anastomosis has become increasingly prevalent and feasible because of increasing cases of adenocarcinoma located in the distal esophagus. 10 In addition, MILE was associated with lower incidence of recurrent laryngeal nerve injury and induces anastomotic leak, stricture, and swallowing dysfunction at lower rates in comparison with MIME. 9 , 10 However, it should be noted that the results for these complications were inconsistent and MILE is not appropriate for patients with esophageal tumors located above the carina, because it might compromise adequate resection margins.…”

Section: Discussionmentioning

confidence: 99%

“… 10 In addition, MILE was associated with lower incidence of recurrent laryngeal nerve injury and induces anastomotic leak, stricture, and swallowing dysfunction at lower rates in comparison with MIME. 9 , 10 However, it should be noted that the results for these complications were inconsistent and MILE is not appropriate for patients with esophageal tumors located above the carina, because it might compromise adequate resection margins. 8 Potential advantages of MIME mainly include improved lymph node dissection and a more proximal resection margin.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Comparison of short-term outcomes between minimally invasive McKeown and Ivor Lewis esophagectomy for esophageal or junctional cancer: a systematic review and meta-analysis

Deng¹,

Su²,

Ren³

et al. 2018

OTT

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PurposeMinimally invasive esophagectomy is increasingly performed for esophageal or gastroesophageal junctional cancer, with advantages of improved perioperative outcomes in comparison with open esophagectomy. McKeown and Ivor Lewis are widely used procedures of minimally invasive esophagectomy, and there have been controversies on which one is preferred for patients with resectable esophageal or junctional cancer.Patients and methodsThis review was registered at the International Prospective Register of Systematic Reviews (number CRD42017075989). Studies in PubMed, Embase, Web of Science, the Cochrane Library, and ClinicalTrials.gov were thoroughly investigated. Eligible studies included prospective and retrospective studies evaluating short-term outcomes of minimally invasive McKeown esophagectomy (MIME) vs minimally invasive Ivor Lewis esophagectomy (MILE) in patients with resectable esophageal or junctional tumors. Main parameters included anastomotic leak and 30-day/in-hospital mortality. Overall incidence rates (ORs)/weighted mean difference (WMD) with 95% confidence intervals (CIs) were calculated by employing random-effects models.ResultsFourteen studies containing 3,468 cases were included in this meta-analysis. Age, male sex, and American Joint Committee on Cancer (AJCC) stage between the 2 groups were not statistically different. MIME led to more blood loss, longer operating time, and longer hospital stay than MILE. MIME was associated with higher incidence of pulmonary complications (OR =1.96, 95% CI =1.28–3.00) as well as total anastomotic leak (OR =2.55, 95% CI =1.40–4.63), stricture (OR =2.07, 95% CI =1.05–4.07), and vocal cord injury/palsy (OR =5.62, 95% CI =3.46–9.14). In addition, the differences of R0 resection rate, number of lymph modes retrieved, blood transfusion rate, length of intensive care unit stay, incidence of cardiac arrhythmia, and Chyle leak between MIME and MILE were not statistically significant. Notably, incidence of severe anastomotic leak (OR =1.28, 95% CI =0.73–2.24) and 30-day/in-hospital mortality (OR =1.76, 95% CI =0.92–3.36) as well as 90-day mortality (OR =2.22, 95% CI =0.71–6.98) between the 2 procedures were also not significantly different.ConclusionThis study suggests that MIME and MILE are comparable with respect to clinical safety. MILE may be a better option when oncologically and clinically suitable. MIME is still a safe alternative procedure when clinically indicated. However, this evidence is at risk for bias; randomized controlled trials are needed to validate or correct our results.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of short-term outcomes between minimally invasive McKeown and Ivor Lewis esophagectomy for esophageal or junctional cancer: a systematic review and meta-analysis

Deng¹,

Su²,

Ren³

et al. 2018

OTT

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“…Methods to reduce the risk of surgery and postoperative complications 3,4 and to improve the thoroughness of the operation remain controversial. 5,6 The number of lymph nodes dissected is one of the most important indexes to evaluate the thoroughness of EC surgery, which is closely related to the total survival of patients. 7,8 Because of the disadvantages of lymph node dissection, the use of Sweet surgery has gradually been reduced.…”

Section: Discussionmentioning

confidence: 99%

Comparison of postoperative complications between different operation methods for esophageal cancer

et al. 2019

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Background We explored the selection of surgical method and differences in postoperative complications in patients with esophageal cancer (EC). Methods The data of 434 patients with EC who underwent thoracic surgery at the Jiangsu Provincial People's Hospital between January 2011 and December 2016 were collected. Patients were divided into three groups: Sweet surgery (143 cases), Ivor–Lewis surgery (232 cases), and minimally invasive esophagectomy (MIE, 59 cases). The number of postoperative days, number of lymph nodes dissected, and incidence of pulmonary infection, serous membrane fluid, arrhythmia, chylous fistula, gastric emptying dysfunction, and anastomotic leakage were recorded. Results A statistically significant number of female stage I patients with upper EC underwent MIE (P < 0.05). Postoperative complications were observed in all three groups but were not statistically significant (P > 0.05). A greater number of lymph nodes were dissected in the Ivor–Lewis group compared to the other groups (P < 0.05). Conclusion Clinically, MIE is often selectively used for women with upper and mid‐early EC, especially in stage I. In our sample, more lymph nodes were dissected in the Ivor–Lewis than in the MIE group, which can reduce recurrence and improve the survival rate. Ivor–Lewis surgery is often used in mid‐lower and terminal EC, while MIE is often used in upper and mid‐early EC. Compared to the other surgical methods, MIE does not increase the risk of postoperative complications. The gradual maturation of MIE technology will further expand indications and increase the number of lymph nodes dissected.

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Intrathoracic vs Cervical Anastomosis After Totally or Hybrid Minimally Invasive Esophagectomy for Esophageal Cancer

Workum¹,

Verstegen²,

Klarenbeek³

et al. 2021

JAMA Surg

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for the ICAN collaborative research group BACKGROUND Transthoracic minimally invasive esophagectomy (MIE) is increasingly performed as part of curative multimodality treatment. There appears to be no robust evidence on the preferred location of the anastomosis after transthoracic MIE.OBJECTIVE To compare an intrathoracic with a cervical anastomosis in a randomized clinical trial. DESIGN, SETTING, AND PARTICIPANTSThis open, multicenter randomized clinical superiority trial was performed at 9 Dutch high-volume hospitals. Patients with midesophageal to distal esophageal or gastroesophageal junction cancer planned for curative resection were included. Data collection occurred from April 2016 through February 2020.INTERVENTION Patients were randomly assigned (1:1) to transthoracic MIE with intrathoracic or cervical anastomosis. MAIN OUTCOMES AND MEASURESThe primary end point was anastomotic leakage requiring endoscopic, radiologic, or surgical intervention. Secondary outcomes were overall anastomotic leak rate, other postoperative complications, length of stay, mortality, and quality of life.RESULTS Two hundred sixty-two patients were randomized, and 245 were eligible for analysis. Anastomotic leakage necessitating reintervention occurred in 15 of 122 patients with intrathoracic anastomosis (12.3%) and in 39 of 123 patients with cervical anastomosis (31.7%; risk difference, −19.4% [95% CI, −29.5% to −9.3%]). Overall anastomotic leak rate was 12.3% in the intrathoracic anastomosis group and 34.1% in the cervical anastomosis group (risk difference, −21.9% [95% CI, −32.1% to −11.6%]). Intensive care unit length of stay, mortality rates, and overall quality of life were comparable between groups, but intrathoracic anastomosis was associated with fewer severe complications (risk difference, −11.3% [−20.4% to −2.2%]), lower incidence of recurrent laryngeal nerve palsy (risk difference, −7.3% [95% CI, −12.1% to −2.5%]), and better quality of life in 3 subdomains (mean differences: dysphagia, −12.2 [95% CI, −19.6 to −4.7]; problems of choking when swallowing, −10.3 [95% CI, −16.4 to 4.2]; trouble with talking, −15.3 [95% CI, −22.9 to −7.7]). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, intrathoracic anastomosis resulted in better outcome for patients treated with transthoracic MIE for midesophageal to distal esophageal or gastroesophageal junction cancer. TRIAL REGISTRATION Trialregister.nl Identifier: NL4183 (NTR4333)

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A standardized comparison of peri-operative complications after minimally invasive esophagectomy: Ivor Lewis versus McKeown

Cited by 42 publications

References 28 publications

Comparison of short-term outcomes between minimally invasive McKeown and Ivor Lewis esophagectomy for esophageal or junctional cancer: a systematic review and meta-analysis

Comparison of short-term outcomes between minimally invasive McKeown and Ivor Lewis esophagectomy for esophageal or junctional cancer: a systematic review and meta-analysis

Comparison of postoperative complications between different operation methods for esophageal cancer

Intrathoracic vs Cervical Anastomosis After Totally or Hybrid Minimally Invasive Esophagectomy for Esophageal Cancer

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