Comparison of Ivor-Lewis versus Sweet procedure for middle and lower thoracic esophageal squamous cell carcinoma

Abstract

Our study compared the Ivor-Lewis and Sweet procedures used for treating middle and lower thoracic esophageal squamous cell carcinoma and assessed the associated perioperative complications and long-term survival rates of the patients. This retrospective study involved 624 middle and lower thoracic esophageal squamous carcinoma patients who received either Ivor-Lewis (n = 325) or Sweet (n = 299) procedures at our hospital. Further, the perioperative conditions and long-term survival rates were analyzed for both groups. Relative to the Sweet group, the Ivor-Lewis group showed lower volume of drainage within 24 hours after operation (400 (300–500) ml vs 550 (400–658) ml, P = .031). Although we found no significant differences in major postoperative complications between the groups (72 (22.2) vs 65 (21.7), P = .90), there were significant differences observed in minor postoperative complications between the Ivor-Lewis and Sweet groups (59 (18.2) vs 32 (10.7), P = .008). Perioperative death rates remained comparable for the 2 groups (2 (0.6) vs 2 (0.7), P > .99). Further, comparison of the 2 groups revealed that the Ivor-Lewis group had increased number of dissected lymph nodes, (20 (4–42) vs 16 (3–31), P < .001), especially in the upper mediastinum (4 (0–5) vs 2 (0–2), P < .001). The long-term survival rates did not differ significantly between the 2 groups (Kaplan-Meier method, P = .95; Cox regression, P = .20). These findings suggest that perioperative complications and long-term survival rates were comparable for both patients groups. Patients receiving the Sweet procedure had reduced minor postoperative complications compared to those receiving the Ivor-Lewis procedure. Due to improved quality of lymph node dissection in the upper mediastinum, the Ivor-Lewis procedure may have advantages over the Sweet procedure for treating patients with esophageal cancer with enlarged lymph nodes in the upper mediastinum.

Comparison of Ivor Lewis and Sweet esophagectomy for middle and lower esophageal squamous cell carcinoma: A systematic review and pooled analysis

“… No. Reference Country Inclusion Period Study Design Cases(I/S) Median Age (years) Location Operative time(min) lymph nodes Hospital stay Anastomotic leakage(I/S) Pulmonary infection(I/S) Laryngeal recurrent nerve injury(I/S) Cardiac complication(I/S) Gastroparesis(I/S) Reoperations(I/S) Neoadjuvant therapy Preoperative radiotherapy I S Middle(I/S) Lower(I/S) I S I S I S 1 Wang 2019 [20] China 2010–2015 Retrospective 624 (325/299) 62 (59–68) 62 (58–68) 182 /181 143/118 165 (150–180) 160 (145–180) 20 (4–42) 16 (3–31) 12 (10–17) 12 (11–15) 18 /11 26/32 8/4 6/10 24/5 11/6 No Yes 2 Li 2018 [ 12 , 15 ] China 2010–2012 Retrospective 300(150/150) 61 (54–66) 60 (55–64) 95/82 55 /68 202 (38) 174 (35) 22 (17–33) 18 (13–26) 16 (10–60) 18 (10–90) 2/8 13/16 3/4 17/21 7/4 ...…”

“…Fig. 2 A shows that seven studies [ 15 , [20] , [21] , [22] , [23] , [24] , [25] ] mentioned the operation time. Due to significant heterogeneity obtained by combined analysis ( I 2 = 99%, p < 0·01), a random effects model was applied.…”

“…The operation time of Ivor Lewis esophagectomy was significantly longer than that of Sweet (MD = 104.30, 95% CI: 64.01–144.59, p < 0.01). Six studies [ 15 , [20] , [21] , [22] , [23] , [24] ] were involved to assess the number of lymph node removed during the operation ( Fig. 2 B ).…”

“…Six articles [ 15 , 20 , 21 , [23] , [24] , [25] ] reported postoperative hospital duration (Supplemental Fig. 2A), one of which [20] had too much data missing. With the study [20] excluded, a random effects model ( I 2 = 86%, p < 0.01) was applied.…”

“…2A), one of which [20] had too much data missing. With the study [20] excluded, a random effects model ( I 2 = 86%, p < 0.01) was applied. As shown in Supplemental Fig.…”