Department of Thoracic Surgery, ZhongShan Hospital, Fudan University, Shanghai, China.
Department of Thoracic Surgery, ZhongShan Hospital, Fudan University, Shanghai, China.
Ann Thorac Surg. 2014 May;97(5):1728-33. doi: 10.1016/j.athoracsur.2014.01.034. Epub 2014 Mar 18.
The Ivor Lewis and Sweet approaches are the two most widely used open transthoracic esophagectomy techniques. We evaluated and compared the therapeutic efficacy of these two approaches to determine the appropriate method to treat middle or lower third esophageal carcinomas.
We retrospectively reviewed patients who underwent esophagectomy with the Sweet (n=748) and Ivor Lewis (n=167) approaches at Zhongshan Hospital, Fudan University between January 2007 and December 2010. Patients with preoperatively identified superior mediastinal lymph node metastases, high-level lesions (above the carina), and benign tumors were excluded. Perioperative-related indicators and 5-year survival rates were compared between groups.
Compared with the Ivor Lewis approach, the Sweet approach has a shorter operative time (181±71 minutes versus 208±63 minutes; p<0.001), less blood loss (167±71 mL versus 179±87 mL; p=0.043), and a lower incidence of transfusion (8.7% versus 13.8%; p=0.044) and postoperative complications (12.3% versus 20.4%; p=0.002). The Ivor Lewis approach was more likely to result in wound infection (3.2% versus 7.8%; p=0.010) and delayed gastric emptying (1.7% versus 4.7%; p=0.046). There was no significant difference between groups with regard to the number of lymph nodes harvested or total number of patients with lymph node metastases. There was no significant difference in locoregional recurrence, distant recurrence, or 5-year survival between approaches.
The Sweet approach has many advantages for the treatment of middle or lower third esophageal carcinomas. It is a safe, effective, and worthwhile approach in modern thoracic surgery.
Ivor Lewis 和 Sweet 入路是两种最广泛使用的开胸食管切除术技术。我们评估并比较了这两种方法的治疗效果，以确定治疗中下段食管癌的合适方法。
我们回顾性分析了 2007 年 1 月至 2010 年 12 月在复旦大学中山医院接受 Sweet（n=748）和 Ivor Lewis（n=167）入路食管切除术的患者。排除术前确定纵隔淋巴结转移、高位病变（隆嵴以上）和良性肿瘤的患者。比较两组患者的围手术期相关指标和 5 年生存率。
与 Ivor Lewis 入路相比，Sweet 入路手术时间更短（181±71 分钟比 208±63 分钟；p<0.001），出血量更少（167±71 毫升比 179±87 毫升；p=0.043），输血发生率（8.7%比 13.8%；p=0.044）和术后并发症发生率（12.3%比 20.4%；p=0.002）更低。Ivor Lewis 入路更容易导致伤口感染（3.2%比 7.8%；p=0.010）和胃排空延迟（1.7%比 4.7%；p=0.046）。两组患者淋巴结清扫数目和淋巴结转移总数无统计学差异。两种方法在局部复发、远处复发和 5 年生存率方面无统计学差异。
Sweet 入路治疗中下段食管癌有许多优点。它是现代胸外科安全、有效、值得推广的方法。
