Objective To systematically evaluate the efficacy and safety of thoraco-laparoscopy combined with Ivor Lewis surgery versus thoraco-laparoscopy combined with McKeown surgery in the treatment of esophageal carcinoma. MethodsPubMed, EMbase, The Cochrane Library, Web of Science, Wanfang database, VIP database and CNKI were searched by computer for the relevant literature comparing the efficacy and safety of Ivor Lewis surgery and McKeown surgery in the treatment of esophageal carcinoma from inception to January 2022. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of cohort studies, and the Cochrane risk of bias tool was used to evaluate the methodological quality of randomized controlled studies. Review Manager 5.4 software was utilized to perform a meta-analysis of the literature. ResultsA total of 33 articles were included, which consisted of 26 retrospective cohort studies, 3 prospective cohort studies and 4 randomized controlled trials. There were 11 518 patients in total, including 5 454 patients receiving Ivor Lewis surgery and 6064 patients receiving McKeown surgery. NOS score was≥7 points. Meta-analysis showed that, in comparison to the McKeown surgery, the Ivor Lewis surgery had shorter operative time (MD=–19.61, 95%CI –30.20 to –9.02, P<0.001), shorter postoperative hospital stay (MD=–1.15, 95%CI –1.43 to –0.87, P<0.001), lower mortality rate during hospitalization or 30 days postoperatively (OR=0.37, 95%CI 0.20 to 0.71, P=0.003), and lower incidence of total postoperative complications (OR=0.36, 95%CI 0.27 to 0.49, P<0.001). The McKeown surgery had an advantage in terms of the number of lymph nodes dissected (MD=–1.25, 95%CI –2.03 to –0.47, P=0.002), postoperative extubation time (MD=0.78, 95%CI 0.37 to 1.19, P<0.001) and 6-month postoperative recurrence rate (OR=1.83, 95%CI 1.41 to 2.39, P<0.001). The differences between the two surgeries were not statistically significant in terms of intraoperative bleeding, postoperative 1 year-, 3 year- and 5 year-overall survival (OS), and impaired gastric emptying (P>0.05). ConclusionCompared with McKeown surgery, Ivor Lewis surgery has shorter operative time, shorter postoperative hospital stay, lower mortality rate during hospitalization or 30 days postoperatively and lower incidence of total postoperative complications. However, in terms of the number of lymph nodes dissected, postoperative extubation time and 6-month postoperative recurrence rate, McKeown surgery has advantages. Both surgeries have comparable results in terms of intraoperative bleeding, postoperative 1 year-, 3 year- and 5 year-OS, and impaired gastric emptying.
Objective To systematically evaluate the short-term efficacy and safety of McKeown and Sweet methods in the treatment of esophageal cancer. Methods PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang, VIP, CNKI and Chinese Biomedical Literature database were searched for literature on the short-term efficacy and safety of McKeown and Sweet methods in the treatment of esophageal cancer published from the establishment to May 2023. Newcastle-Ottawa Scale was used to evaluate the quality of researches, and meta-analysis was performed using RevMan5.4. Results A total of 9 articles were included, involving 3687 patients including 1019 in the McKeown group and 2668 in the Sweet group. NOS score was 8-9 points. There were no statistical differences in the age, sex or American Joint Committee on Cancer stage between the two groups (P>0.05). Patients in the McKeown group had longer operative time and hospital stay, more intraoperative blood loss, and higher Eastern Cooperative Oncology Group scores than those in the Sweet group (P<0.05). However, the McKeown operation could remove more lymph nodes (P=0.001). In terms of safety, the incidences of pulmonary complications [OR=2.20, 95%CI (1.40, 3.46), P=0.001] and postoperative anastomotic leakage [OR=2.06, 95%CI (1.45, 2.92), P=0.001] were higher in the McKeown group than those in the Sweet group. In addition, there were no statistical differences between the two groups in the Karnofsky score, cardiac complications, vocal cord injury or paralysis, chylous leakage, or gastric emptying (P>0.05). Conclusion Compared with McKeown, Sweet method has advantages in operation time, intraoperative blood loss and hospital stay, and has lower incidence of postoperative pulmonary complications and anastomotic leakage. However, McKeown has more lymph node dissection.
ObjectiveTo compare the short-term outcomes of Da Vinci robot-assisted minimally invasive esophagectomy (RAMIE) and video-assisted thoracoscopic-laparoscopic minimally invasive esophagectomy (VAMIE) for esophageal cancer. MethodsA retrospective analysis was conducted on the data of patients with esophageal cancer admitted to Gansu Provincial People's Hospital from January 2021 to February 2025. Based on the surgical method, patients were divided into a RAMIE group and a VAMIE group. Both groups underwent standard McKeown three-incision surgery and systematic three-field lymph node dissection. Intraoperative blood loss, number of lymph nodes dissected, postoperative recovery indicators, and complication rates were compared. ResultsA total of 126 patients with esophageal cancer were included, of which 109 were male and 17 were female, with an average age of (64.6±8.8) years. The RAMIE group consisted of 36 patients and the VAMIE group 90 patients. There was no statistical difference in baseline indicators such as age, sex, and body mass index between the two groups (P>0.05). The difference in operation time between the two groups was not statistically significant [305.0 (280.0, 348.0) min vs. 300.0 (268.8, 340.0) min, P=0.457]. Compared with the VAMIE group, the RAMIE group had less intraoperative blood loss [100.0 (100.0, 120.0) mL vs. 100.0 (100.0, 200.0) mL, P=0.035], more intraoperative fluid infusion [(2244.7±610.3) mL vs. (1954.4±457.9) mL, P=0.013], a higher number of lymph nodes dissected [(27.9±10.6) nodes vs. (21.3±5.1) nodes, P<0.001], and the difference in the number of lymph node dissection groups was not statistically significant [8.0 (6.0, 8.0) groups vs. 7.0 (5.0, 8.0) groups, P=0.268]. In terms of postoperative recovery indicators, compared with the VAMIE group, the RAMIE group had shorter postoperative hospital stay [12.5 (9.0, 18.0) d vs. 17.0 (14.0, 22.0) d, P＜0.001] and shorter time with tubes [9.0 (8.0, 10.0) d vs. 10.0 (9.0, 12.0) d, P=0.007]. In terms of postoperative complications, the incidence of recurrent laryngeal nerve injury in the RAMIE group was significantly lower than that in the VAMIE group (2.8% vs. 16.7%, P=0.039), there was no statistical difference in pulmonary infection, anastomosis leakage, and incision infection between the two groups (P>0.05). The total hospitalization cost of the RAMIE group was significantly higher than that of the VAMIE group (P<0.001). ConclusionRAMIE has significant advantages over VAMIE in terms of intraoperative bleeding control, the number of lymph node dissections, postoperative recovery speed, and reducing the risk of incision infection and recurrent laryngeal nerve injury, with good safety and feasibility.