Xue Yuhang, Chen Donglai, Wang Wei, Wang Wenjia, Chen Lei, Sang Yonghua, Chen Yongbing, Xu Weihua
Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China.
EClinicalMedicine. 2020 Oct 10;27:100497. doi: 10.1016/j.eclinm.2020.100497. eCollection 2020 Oct.
Lack of robust evidence highlights the important need to address the controversy on the clinical safety and effectiveness between Ivor Lewis versus Sweet procedure for middle and lower esophageal squamous cell carcinoma (ESCC).
Search results were filtered according to certain criteria and were analyzed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
The inter-study heterogeneity was high. Ivor Lewis procedure might be associated with longer operation time ( < 0.01) and higher lymph node yield ( < 0.01) compared with Sweet procedure. There was no significant difference in the length of hospital stay and postoperative complications with similar reoperation rate between the two procedures ( > 0.05). As the combined analysis of survival data revealed, there was no statistical difference in the oncologic efficacy of them ( = 0.97).
The present study based on retrospective data with high heterogeneity indicated that Ivor Lewis esophagectomy might be associated with increased lymph node yield but longer operation time than Sweet. Prospective studies are warranted to compare the long-term survival of Ivor Lewis esophagectomy versus Sweet for middle and lower ESCC.
缺乏有力证据凸显了解决Ivor Lewis术式与Sweet术式治疗中下段食管鳞状细胞癌（ESCC）的临床安全性和有效性争议的迫切需求。
根据特定标准对检索结果进行筛选，并按照系统评价与Meta分析的首选报告项目指南进行分析。
研究间异质性较高。与Sweet术式相比，Ivor Lewis术式可能与更长的手术时间（P<0.01）和更高的淋巴结清扫数量（P<0.01）相关。两种术式的住院时间、术后并发症及再次手术率相似，差异无统计学意义（P>0.05）。生存数据的合并分析显示，两者的肿瘤学疗效无统计学差异（P=0.97）。
本研究基于异质性较高的回顾性数据表明，Ivor Lewis食管切除术可能会增加淋巴结清扫数量，但手术时间比Sweet术式长。有必要进行前瞻性研究，比较Ivor Lewis食管切除术与Sweet术式治疗中下段ESCC的长期生存情况。
