Zhou Shihong, Zhang Ying, Cao Jinlin, Xu Jianxin, Xu Wenzhen, Yang Gang, Lv Wang, Hu Jian
Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, 200433, China.
Langenbecks Arch Surg. 2025 Jul 16;410(1):223. doi: 10.1007/s00423-025-03779-5.
This study aimed to compare long-term survival outcomes between Ivor-Lewis and McKeown esophagectomy with two-field(thoracic-abdominal) lymphadenectomy in resectable middle or lower thoracic esophageal squamous cell carcinoma.
Patients with resected middle or lower thoracic esophageal squamous cell carcinoma undergoing Ivor-Lewis or McKeown esophagectomy with two-field lymphadenectomy were enrolled and categorized into two respective groups. Propensity score matching was performed to minimize selection bias. And subgroup analyses, including stratification by tumor invasion area of thoracic esophagus, were conducted to compare survival outcomes via Kaplan-Meier method.
Totally 281 cases were included(Ivor-Lewis group: n = 199; McKeown group: n = 82). Neither the incidence/severity of complications nor survival outcomes differed significantly between the two surgical approaches in either the full cohort or the propensity score matching cohort. In patients with middle-upper or middle thoracic esophagus invasion, Ivor-Lewis esophagectomy demonstrated superior overall survival(P = 0.004). Conversely, for patients with middle-lower or lower thoracic esophagus invasion, McKeown esophagectomy showed survival advantages in both overall survival(P = 0.001) and disease-free survival(P = 0.006).
For resectable middle or lower thoracic esophageal squamous cell carcinoma treated with two-filed lymphadenectomy, Ivor-Lewis esophagectomy provides long-term survival in patients with middle-upper or middle thoracic esophageal invasion, whereas McKeown esophagectomy demonstrated significant survival benefits for patients with middle-lower or lower thoracic esophageal invasion.
本研究旨在比较Ivor-Lewis术式和McKeown术式行两野（胸腹部）淋巴结清扫治疗可切除的胸段中下段食管鳞状细胞癌的长期生存结局。
纳入接受Ivor-Lewis术式或McKeown术式行两野淋巴结清扫的胸段中下段食管鳞状细胞癌切除患者，并分为两个相应的组。进行倾向评分匹配以尽量减少选择偏倚。通过Kaplan-Meier法进行亚组分析，包括按胸段食管肿瘤侵犯区域分层，以比较生存结局。
共纳入281例患者（Ivor-Lewis组：n = 199；McKeown组：n = 82）。在整个队列或倾向评分匹配队列中，两种手术方式的并发症发生率/严重程度及生存结局均无显著差异。在胸段食管中上段或中段侵犯的患者中，Ivor-Lewis食管切除术显示出更好的总生存率（P = 0.004）。相反，对于胸段食管中下段或下段侵犯的患者，McKeown食管切除术在总生存率（P = 0.001）和无病生存率（P = 0.006）方面均显示出生存优势。
对于行两野淋巴结清扫治疗的可切除胸段中下段食管鳞状细胞癌，Ivor-Lewis食管切除术为胸段食管中上段或中段侵犯的患者提供长期生存，而McKeown食管切除术对胸段食管中下段或下段侵犯的患者显示出显著的生存获益。
