Long-term outcomes after Ivor-Lewis versus McKeown esophagectomy with two-field lymphadenectomy for resectable middle or lower thoracic esophageal squamous cell carcinoma.

Abstract

Purpose: 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.

Methods: 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.

Results: 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).

Conclusion: 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.