Ivor-Lewis Group Research Articles

646. MCKEOWN VS IVOR-LEWIS ESOPHAGECTOMY FOR PATIENTS WITH A HISTORY OF TOTAL PHARYNGOLARYNGECTOMY: A COMPARISON STUDY

Abstract Background Oncologic esophagectomy in patients with a history of total pharyngolaryngectomy (TPL) is challenging. There are two different esophagectomy procedures: total esophagectomy with cervical anastomosis (McKeown) and subtotal esophagectomy with intrathoracic anastomosis (Ivor-Lewis). Differences in outcomes between McKeown and Ivor-Lewis esophagectomies for patients with this history remain unclear. Patients and Methods We retrospectively reviewed 36 patients with a history of TPL who underwent oncologic esophagectomy and compared the clinical outcomes between the procedures. Results Twelve (33.3%) and 24 (66.7%) patients underwent McKeown and Ivor-Lewis esophagectomies, respectively. McKeown esophagectomy was more frequently performed for the supracarinal tumors (P = 0.002). Other baseline characteristics, including the history of radiation therapy, were comparable between the groups. Postoperatively, the incidences of pneumonia and anastomotic leakage were higher in the McKeown group than in the Ivor-Lewis group (P = 0.029 and P < 0.001, respectively). Neither tracheal necrosis nor remnant esophageal necrosis was observed. The overall and recurrence-free survival rates were comparable between the groups (P = 0.494 and P = 0.813, respectively). Conclusion When performing esophagectomy for patients with a history of TPL, if it is oncologically acceptable and technically available, Ivor-Lewis is preferable over McKeown esophagectomy for avoiding postoperative complications.

Esophagectomy for esophageal cancer in patients with a history of total pharyngolaryngectomy: a Japanese nationwide retrospective cohort study.

Second primary esophageal cancer often develops in patients with head and neck cancer, and esophagectomy in patients with a history of total pharyngolaryngectomy (TPL) is challenging. However, the clinical outcomes of these patients have yet to be examined in a multicenter setting. We evaluated the surgical outcomes of a nationwide cohort of 62 patients who underwent esophagectomy for esophageal cancer with a history of TPL. Ivor-Lewis and McKeown esophagectomies were performed in 32 (51.6%) and 30 (48.4%) patients, respectively. Postoperatively, 23 patients (37.1%) developed severe complications, and 7 patients (11.3%) required reoperation within 30days. Pneumonia and anastomotic leakage occurred in 13 (21.0%) and 16 (25.8%) patients, respectively. Anastomotic leakage occurred more frequently in the McKeown group than in the Ivor-Lewis group (46.7% vs. 6.2%, P < 0.001). The adjusted odds ratio for anastomotic leakage in the McKeown group was 9.64 (95% confidence intervals (CI), 2.11-70.82, P = 0.008). Meanwhile, the 5-year overall survival rates were comparable between the groups (41.8% for Ivor-Lewis and 42.7% for McKeown), and the adjusted hazard ratio of overall survival was 1.44 (95% CI, 0.64-3.29; P = 0.381; Ivor-Lewis as the reference). In our cohort, anastomotic leakage occurred more frequently after McKeown than Ivor-Lewis esophagectomy, and almost half of patients in the McKeown group experienced leakage. Ivor-Lewis esophagectomy is preferred for decreasing anastomotic leakage when oncologically and technically feasible.

Comparison of the Oncologic Outcomes for Patients with Middle to Lower Esophageal Squamous Cell Carcinoma Undergoing Surgical Treatment Using the Ivor-Lewis or McKeown Operation.

The upper mediastinum is the most common metastatic site of esophageal squamous cell carcinoma (ESCC), and complete dissection of this region is important for oncologic reasons. This study aimed to compare the oncologic outcomes and completeness of upper mediastinal dissection for ESCC patients undergoing the Ivor-Lewis (IL) or McKeown (MK) operations. Between 2013 and 2018, 680 patients (IL, 433; MK, 247) underwent upfront esophagectomy with two-field lymph node (LN) dissection for mid-to-lower ESCCs. Propensity score-matching (1:1 ratio) was performed to minimize the effects of confounding factors. The mean age was 64.5±8.8 years, and 635 (93.4%) of the patients were male. The median follow-up period was 71.66 months (interquartile range [IQR], 59.60-91.04 months). The IL group had a higher mean age, lower body mass index, higher proportion of advanced T and N, and higher adjuvant therapy rates, but these differences were well-balanced after propensity score-matching. The mean number of dissected LNs at the mediastinum and at the right recurrent laryngeal nerve (RLN) were similar between the two groups after matching, whereas the IL group exhibited a slightly greater number of dissected LNs at the left RLN. Among the matched patients, the IL and MK groups exhibited similar 5-year overall survival (OS: 75.1% vs 78.0%; p=0.368). The multivariate model showed no differences in OS, disease-free survival, or recurrence-free survival for locoregional, upper mediastinum, or neck between the two groups. This study suggests that both the IL and MK operations are oncologically feasible for patients with mid-to-lower ESCC.

Comparison of Clinical Efficacy Between Da Vinci Robot-Assisted Ivor Lewis Esophagectomy and McKeown Esophagectomy for Middle and Lower Thoracic Esophageal Cancer: A Multicenter Propensity Score-Matched Study.

We compared the perioperative efficacy and safety of da Vinci robot-assisted Ivor Lewis esophagectomy and McKeown esophagectomy for middle and lower thoracic esophageal cancer. A retrospective case-control study method was used. A total of 181 patients with esophageal cancer admitted to three medical centers in China from February 2018 to October 2022 were collected and divided into two groups according to surgical method: da Vinci robot-assisted thoracic surgery (RATS) Ivor Lewis esophagectomy (Ivor Lewis group) and RATS McKeown esophagectomy (McKeown group), respectively. Propensity score matching (PSM) analysis was used to reduce selection bias caused by confounding factors. The perioperative indicators of the two groups were compared and analyzed. There was a statistically significant difference in age and tumor location between the Ivor Lewis group and the McKeown group. After PSM, the above factors were no longer statistically significant. There were 80 patients in each group after PSM. In terms of operative time (P = 0.005), anastomotic leakage (P = 0.029), and pulmonary infection (P = 0.035), the Ivor Lewis group has significant advantages; in terms of the number of lymph nodes dissected around the recurrent laryngeal nerve (P = 0.010), the McKeown group has significant advantages. Both RATS Ivor Lewis esophagectomy and McKeown esophagectomy are safe and effective for treatment of middle and lower thoracic esophageal cancer. Ivor Lewis has advantages in operative time, anastomotic leakage, and pulmonary infection, while McKeown has advantage in lymph node dissection around the recurrent laryngeal nerve.

McKeown Versus Ivor-Lewis Esophagectomy for Patients with a History of Total Pharyngolaryngectomy: A Comparison Study.

Oncologic esophagectomy in patients with a history of total pharyngolaryngectomy (TPL) is challenging. There are two different esophagectomy procedures: total esophagectomy with cervical anastomosis (McKeown) and subtotal esophagectomy with intrathoracic anastomosis (Ivor-Lewis). Differences in outcomes between McKeown and Ivor-Lewis esophagectomies for patients with this history remain unclear. We retrospectively reviewed 36 patients with a history of TPL who underwent oncologic esophagectomy and compared the clinical outcomes between the procedures. Twelve (33.3%) and 24 (66.7%) patients underwent McKeown and Ivor-Lewis esophagectomies, respectively. McKeown esophagectomy was more frequently performed for the supracarinal tumors (P = 0.002). Other baseline characteristics, including the history of radiation therapy, were comparable between the groups. Postoperatively, the incidences of pneumonia and anastomotic leakage were higher in the McKeown group than in the Ivor-Lewis group (P = 0.029 and P < 0.001, respectively). Neither tracheal necrosis nor remnant esophageal necrosis was observed. The overall and recurrence-free survival rates were comparable between the groups (P = 0.494 and P = 0.813, respectively). When performing esophagectomy for patients with a history of TPL, if it is oncologically acceptable and technically available, Ivor-Lewis is preferable over McKeown esophagectomy for avoiding postoperative complications.

Clinical observation on perioperative complications of minimally invasive Ivor-Lewis and minimally invasive McKeown esophagectomy

Objective: To compare and analyze the perioperative clinical effects of minimally invasive Ivor-Lewis esophagectomy (MIE-Ivor-Lewis) and minimally invasive McKeown esophagectomy (MIE-McKeown). Methods: A total of 147 patients who underwent endoscopic esophageal cancer surgery from April 2018 to August 2019 were selected, including 85 patients undergoing MIE-McKeown surgery and 62 patients undergoing MIE-Ivor-Lewis surgery. The measurement data were expressed as (x±s), the comparison of normally distributed measurement data was performed by independent sample t-test, and the comparison of count data was performed by χ(2) test or Fisher's exact test. Results: The operation time of McKeown (M) group and Ivor-Lewis (IL) group were (219.2±72.4) minutes and (225.8±65.3) minutes. The mediastinal lymph node dissection number of M and IL groups were 13.3±4.8 and 11.6±6.5, respectively. The number of left recurrent laryngeal nerve lymph node dissection were 3.5±1.2 and 3.1±1.4, respectively. The intraoperative blood loss were (178.3±41.3) ml and (163.2±64.1) ml, respectively. The number of patients reoperated for postoperative bleeding were 1 and 0, respectively. The number of patients with postoperative gastric bleeding were 0 and 1, respectively. The postoperative chest tube retention time were (2.8±1.3) days and (3.1±1.2) days, respectively. The number of patients with anastomotic leakage were 7 and 1, respectively. The number of patients with lung infection were 13 and 5, respectively, and with chylothorax were 2 and 1, respectively, without statistically significant difference (P>0.05). The number of patients with hoarseness were 11 and 3, respectively. The total incidence of complication were 41.2% (35/85) and 17.7% (11/62), and the postoperative hospital stay were (14.7±6.5) days and (12.3±2.3) days, with statistical difference (P<0.05). Conclusion: MIE-Ivor-Lewis and MIE-McKeown are safe and effective in treating esophageal cancer, but the complication of MIE-Ivor-Lewis is less than that of MIE-Mckeown, and the perioperative clinical effect of MIE-Ivor-Lewis is better than that of MIE-McKeown.

Comparison of the surgical outcomes of McKeown minimally invasive esophagectomy and Ivor-Lewis esophagectomy for the treatment of middle esophageal cancer: A single-center retrospective study

BackgroundIn China, the esophageal cancer is the most common tumor type, and the main treatment is still surgical treatment. Over the past decade, thoracic laparoscopy combined with esophageal cancer resection and neck anastomosis---McKeown minimally invasive esophagectomy (MIE) has gained interest and known as a minimally invasive surgery for the middle esophageal cancer. However, the safety and operability of McKeown MIE remains to be confirmed clinically. The purpose of this article is to examine the clinical safety and operability of McKeown MIE, and compare the security and outcomes of McKeown MIE and Ivor-Lewis esophagectomy. Materials and methodsThe clinical data of 312 patients with middle esophageal cancer in Sir Run Run Shaw Hospital from January 2013 to December 2018 were retrospectively analyzed. Among them, 176 patients underwent Ivor-Lewis esophagectomy and 136 patients underwent McKeown MIE. Patients' demographics and perioperative outcomes were comparable between the two groups. ResultsThere were no significant differences in terms of operative time, postoperative hospital stay, restore fluid diet time, pathology, tumor node metastasis staging between the two groups. In the McKeown MIE group, the intraoperative blood loss was less than that in the Ivor-Lewis group (116.54 ± 80.99 ml vs 152.78 ± 115.35 ml, p = 0.001). The total number of lymph nodes and the number of lymph nodes dissection in bilateral recurrent laryngeal nerves were more than those in the Ivor-Lewis group (30.04 ± 14.08 vs 27.51 ± 11.34, p = 0.039; 5.74 ± 4.27 vs 1.80 ± 2.68, p < 0.001). There were no significant differences in the incidence of complications. The overall survival for the McKeown MIE group was higher than the Ivor-Lewis group (p = 0.013) and no significant difference was found on disease-free survival. ConclusionMcKeown MIE is safe and operational for middle esophageal cancer, which is consistent with the principle of tumor radicalization.

P13 DIFFERENCE IN LONG-TERM QUALITY OF LIFE BETWEEN MCKEOWN AND IVOR LEWIS ESOPHAGECTOMY

Abstract Aim The purpose of this study was to investigate the difference in long-term health-related quality of life (HR-QoL) between McKeown and Ivor Lewis esophagectomy in a tertiary referral center. Background &amp; Methods The therapy of esophageal cancers consist of (neo)adjuvant chemo(radio)therapy and surgery. Often different surgical approaches are possible such as transthoracic esophagectomy with a cervical anastomosis (McKeown) or an intrathoracic anastomosis (Ivor Lewis). Evidence is scarce on whether either of these approaches is better in terms of survival, perioperative morbidity, pathology results and quality of life. Patients with mid-, distal esophageal, gastroesophageal (GEJ) or cardia carcinoma who have undergone a McKeown or an Ivor lewis esophagectomy in the period of 2003 – 2018 were included in this study. EORTC QLQ-C30 and EORTC QLQ-OG25 questionnaires were handed out during the outpatient clinic visits and a follow-up of at least one year was ensured. Problems with eating, reflux and nausea and vomiting were chosen as primary HR-QoL domain endpoints while the remaining HR-QoL domains, postoperative complications and pathology results were observed as secondary endpoints. Correction for confounders age and gender was performed. Results 147 patients were included in the McKeown group and 120 in the Ivor Lewis group. Mean age was 63.5 years and median follow-up was three years (range 12-137 months). No significant difference was found in problems with eating, reflux and nausea and vomiting. Significantly more problems with eating with others were found in McKeown group (β=10.435, 95% CI 4.474 – 16.395) and anastomotic leakage was significantly more common after McKeown esophagectomy (p=0.004). No significant difference was found in Clavien Dindo classification. During Ivor Lewis esophagectomy significantly more lymph nodes were resected (p&lt;0.001). Number of lymph node metastases and R0 resection rate did not differ between groups. Conclusion No major differences in long-term HR-QoL were found in patients with mid-, distal esophageal, GEJ or cardia carcinoma following McKeown or Ivor Lewis esophagectomy. Problems with eating with others and anastomotic leakages were more common after McKeown esophagectomy, however, Clavien Dindo classification and radicality of surgery were similar between the two groups. Results of this study could assist the patient during the decision-making process prior to the surgery.

O19 OUTCOMES OF IVOR LEWIS VERSUS MCKEOWN OESOPHAGECTOMY FOR CANCER: A PROPENSITY SCORE MATCHED ANALYSIS OF THE NETHERLANDS CANCER REGISTRY

Abstract Aim The aim this study was to investigate possible differences in outcomes between Ivor-Lewis (IL) versus McKeown esophagectomy (MK) in a population based cohort. Background It is unknown whether IL or MK should be preferred in patients with potentially curable locoregionally oesophageal or gastro-oesophageal junction (GEJ) cancer. Methods Oesophageal and GEJ cancer patients without distant metastases who underwent a transthoracic oesophagectomy between 2015 and 2017 were selected from the Netherlands Cancer Registry. Patient and tumour characteristics, and treatment outcomes were analysed and compared between IL and MK after propensity score matching (PSM). Patients were matched based on sex, age, tumour morphology and topography, comorbidities, neoadjuvant treatment, cT and cN stage, ASA-score and hospital volume. Postoperative complications and survival were compared between both groups using Chi-Square and multivariable Cox regression analyses. In the multivariable Cox regression analyses we corrected for infectious complications (wound complications and pneumonia) and anastomotic leakage to investigate its effect on survival. Results Off all 1764 included patients (1201 IL patients and 563 MK patients), 948 patients remained after matching. Significantly more lymph nodes were yielded after IL compared to MK (P=0.02). Surgical radicality did not differ between both groups (P=0.25). The complication rate was significantly lower in the IL group regarding anastomotic leakage (17% vs. 28%, P&lt;0.0007) and recurrent laryngeal nerve palsy (2% vs. 6%, P&lt;0.001). Cardiac complications were seen more frequently in patients who underwent IL (17% vs. 11%, P&lt;0.02). No differences were observed in 30 day and 90 day mortality. Kaplan-Meier showed a better survival for IL (63%) compared to MK (58%) (log-rank p=0.07). When correcting for anastomotic leakage and infectious complications the difference in survival remained (HR=0.84, 95% CI 0.69 – 1.03). Similar results regarding postoperative complications and survival were observed in the unmatched cohort. Conclusion Patients who underwent an IL have better outcomes in terms of anastomotic leakage and recurrent laryngeal nerve palsy rate and overall survival compared to MK. The difference in survival appears not to be related to the differences in infectious complications. Based on these results, IL appears to be the treatment of choice in patients in whom both oncological resections are appropriate.

Comparison of Ivor Lewis esophagectomy and Sweet esophagectomy for the treatment of middle-lower esophageal squamous cell carcinoma.

For cancer of the middle and/or lower segment of thoracic esophagus, the Ivor Lewis esophagectomy is the mainstream standard surgery, whereas the Sweet procedure is widely used in China. As no consensus has been reached about the choice of different thoracic approaches, we designed this retrospective study to investigate and compare oncological benefits of the two surgical approaches. After propensity score matching, 150 patients who underwent the Sweet or Ivor Lewis esophagectomy from August 2003 to December 2009 in the Beijing Cancer Hospital were reviewed. We compared the postoperative recovery, nutritional parameters, and survival of the two different surgical approaches. The 5-year overall survival (OS) rate for the whole group was 48.5%, and the 10-year OS rate was 35.6%. The Ivor Lewis group had a longer operation time, longer duration of chest tube drainage, and a larger volume of total thoracic drainage. No significant differences were found between the two groups in terms of the duration of systemic inflammatory response syndrome (SIRS), length of postoperative hospital stay, duration of postoperative nasogastric tube use, incidence of major complications, and nutritional status after the esophagectomy. The OS rates were similar in both groups. The Sweet and Ivor Lewis esophagectomy are both safe and effective. A change of the surgical incision may not be the best way to increase survival, and the choice of surgical procedure should depend on the preference of the thoracic surgeon to secure the safety of the operation.

Comparison of postoperative complications between different operation methods for esophageal cancer.

BackgroundWe explored the selection of surgical method and differences in postoperative complications in patients with esophageal cancer (EC).MethodsThe data of 434 patients with EC who underwent thoracic surgery at the Jiangsu Provincial People's Hospital between January 2011 and December 2016 were collected. Patients were divided into three groups: Sweet surgery (143 cases), Ivor–Lewis surgery (232 cases), and minimally invasive esophagectomy (MIE, 59 cases). The number of postoperative days, number of lymph nodes dissected, and incidence of pulmonary infection, serous membrane fluid, arrhythmia, chylous fistula, gastric emptying dysfunction, and anastomotic leakage were recorded.ResultsA statistically significant number of female stage I patients with upper EC underwent MIE (P < 0.05). Postoperative complications were observed in all three groups but were not statistically significant (P > 0.05). A greater number of lymph nodes were dissected in the Ivor–Lewis group compared to the other groups (P < 0.05).ConclusionClinically, MIE is often selectively used for women with upper and mid‐early EC, especially in stage I. In our sample, more lymph nodes were dissected in the Ivor–Lewis than in the MIE group, which can reduce recurrence and improve the survival rate. Ivor–Lewis surgery is often used in mid‐lower and terminal EC, while MIE is often used in upper and mid‐early EC. Compared to the other surgical methods, MIE does not increase the risk of postoperative complications. The gradual maturation of MIE technology will further expand indications and increase the number of lymph nodes dissected.

Comparison of postoperative complications between four surgery models in elderly esophageal cancer patients

Objective To investigate the surgical methods and the differences of postoperative complications in esophageal cancer patients aged 60 years and over undergoing different operation models. Methods A total of 542 elderly esophageal cancer patients who underwent thoracic surgery at our hospital between January 2010 and December 2016 were enrolled. Patients were divided into 4 groups: left thoracic incision operation group (n=202) , Ivor-Lewis two incisions operation group (right chest posterolateral and upper abdomen median) (n=251), three incision operation group (left neck-right chest-abdominal midian (n=29), and McKneown under-endoscope minimally invasive operation group (n=60). Clinical data, including the postoperative days, numbers of lymph nodes dissection, pulmonary infection, serous membrane fluid, arrhythmia, chylous fistula, gastric emptying dysfunction and anastomotic leakage, were retrospectively compared between the four groups. Results There was no significant difference in the postoperative days, serous membrane fluid, arrhythmia, chylous fistula, gastric emptying dysfunction and anastomotic leakage (P>0.05). The number of lymph nodes dissection in Sweet group, Ivor-Lewis group, Mckeown operation group and minimally invasive Mckneown group were (12.9±7.4)、(19.3±8.6)、(14.3±6.9)and(15.4±7.3)respectively.The number of lymph nodes dissection was more in the Ivor-Lewis group than in the other three groups (F=23.915, P=0.000). Sweet group, Ivor-Lewis group, Mckeown group and minimally invasive Mckneown group were 31.7%、40.2%、24.1% and 50.0% respectively.The incidence of pulmonary infection was higher in the minimally invasive surgery group than in the other three groups (χ2=9.941, P = 0.019). Conclusions Ivor-Lewis surgery is more effective in lymph nodes dissection and has a lower incidence of complications in elderly esophageal cancer patients.The minimally invasive surgery group has a higher incidence of pulmonary infection than in the other surgical groups, which may be related with the immaturity of endoscopic technique. Key words: Esophageal neoplasms; Surgical procedures, operative; Postoperative complications

Intrathoracic Anastomosis or Cervical Anastomosis for Esophagogastric Junction Cancer Surgery: A Retrospective Cohort Study

Aims: This study aimed to determine the degree of reflux esophagitis after either intrathoracic or cervical esophagogastrostomy in patients with esophagogastric junction carcinoma. Patients and Methods: The study population consisted of 10 and 15 consecutive patients who underwent esophagectomy with gastric conduit reconstruction via intrathoracic (Ivor Lewis) or cervical (McKeown) esophagogastrostomy, respectively. Reflux esophagitis was evaluated annually after surgery and scored on a 0- to 4-point scale corresponding to grades N/M, A, B, C, and D, respectively. The reflux esophagitis score of each patient, defined as the average of scores at 1, 2, and 3 years after surgery, was compared between the groups. Results: Of the 30 planned annual endoscopic follow-ups (3 years in 10 patients) in the Ivor Lewis group and 45 planned follow-ups (3 years in 15 patients) in the McKeown group, 24 and 29 such follow-ups were performed in the Ivor Lewis and McKeown groups, respectively. The reflux esophagitis score was significantly better in the McKeown group than in the Ivor Lewis group (0.51 ± 0.24 versus 1.46 ± 0.29, P = 0.019). Overall survival did not significantly differ between the Ivor Lewis and McKeown groups (respective 5-year survival rates, 64% versus 57%, P = 0.75). Conclusions: The degree of reflux esophagitis may be greater in patients with esophagogastric junction cancer treated by Ivor Lewis esophagectomy than in those treated by McKeown esophagectomy. McKeown esophagectomy might be a more suitable method for the treatment of esophagogastric junction cancer with extended esophageal invasion.

Comparison of Long-term Quality of Life in Patients with Esophageal Cancer after Ivor-Lewis, Mckeown, or Sweet Esophagectomy

BackgroundThe aim of this study was to compare the long-term quality of life (QoL) in patients after Sweet, Ivor-Lewis, or Mckeown esophagectomy. MethodsEsophageal cancer patients after Sweet, Ivor-Lewis, or Mckeown esophagectomy from 2010 to 2012 were included. QoL was assessed according to the European Organization for Research and Treatment of Cancer general questionnaire: QLQ-C30 and esophagus-specific questionnaire: QLQ-OES18. ResultsA total of 126 qualified patients who have been alive for more than 3 years without tumor recurrence were divided into three groups: the Sweet group (n = 40), Ivor-Lewis group (n = 38), and Mckeown group (n = 48). Among these three groups, the QLQ-C30 mean scores of global health status, functional and symptom scales, and general QoL were similar. The symptom scales of QLQ-OSE18 showed that patients who had a Mckeown operation experienced more problem of eating (P = 0.029), choking when swallowing (P = 0.010) and coughing (P = 0.016), while patients undergoing Sweet operation complained more symptom of reflux (P = 0.003) and pain (P = 0.000). ConclusionsAll three types of esophagectomy provided a generally good long-term QoL. However, patients in Sweet and Mckeown group tend to suffer from a higher symptomatic burden as compared to Ivor-Lewis approach.

BRF2 as a promising indicator for radical lymph-node dissection surgery in patients with cN0 squamous cell carcinoma of the middle thoracic esophagus.

Radical lymph-node dissection surgery in patients with cN0 middle thoracic esophageal squamous cell carcinoma (ESCC) remains controversial. We sought a novel biomarker that could be used for decision-making in relation to radical lymph-node dissection. One hundred and nineteen patients with cN0 middle thoracic ESCC undergoing three-field lymph-node dissection (3FLND) or two-field lymph-node dissection (Ivor Lewis) esophagectomy were reviewed. A survival analysis, and Chi-square and parametric tests were performed. A Cox regression analysis revealed that the expression of BRF2 was an independent prognostic factor for overall survival (P = 0.014) and progression-free survival (P = 0.014). The survival of patients who underwent 3FLND was better than that of patients who underwent Ivor Lewis esophagectomy in the BRF2 overexpression group (P = 0.002), but not in the BRF2 nonoverexpression group (P = 0.386). The risk of lymph-node recurrence and the number of recurrent lymph nodes in patients with the overexpression of BRF2 were increased in the Ivor Lewis group in comparison to the 3FLND group (P = 0.01 and P < 0.001). The risk of cervical and superior mediastinal lymph-node recurrence was positively correlated with the overexpression of BRF2 (P = 0.027). Furthermore, in the Ivor Lewis group, a significant correlation was found between the risk of lymph-node recurrence or the number of recurrent lymph nodes and the expression of BRF2 (P = 0.002 and P = 0.004), but not in the 3FLND group (P = 0.193 and P = 0.694). 3FLND generated better survival outcomes and reduced the rate of lymph-node recurrence in comparison to Ivor Lewis in patients with the overexpression of BRF2. BRF2 can be used as an indicator for radical lymph-node dissection surgery in cN0 ESCC patients.

PS01.122: LONG-TERM QUALITY OF LIFE IN PATIENTS AFTER MCKEOWN VERSUS IVOR LEWIS ESOPHAGECTOMY

Abstract Background Treatment of distal esophageal and gastroesophageal junction (GEJ) cancers is challenging. The therapy for these cancers mainly consist of (neo)adjuvant chemo(radio)therapy and surgery. There are different surgical approaches possible for these patients: transthoracic esophagectomy with a cervical anastomosis (McKeown) or an intrathoracic anastomosis (Ivor Lewis). However, there is no evidence which is the preferred approach in terms of oncology, morbidity and quality of life. The aim of this study was to investigate the difference in the long-term quality of life in patients undergoing McKeown (McK) versus Ivor Lewis (IL) esophagectomy in a tertiary referral center. Methods Consecutive patients after either McK or IL for distal oesophagus, GEJ or proximal gastric carcinoma were asked to fill in EORTC QLQ-C30 and EORTC QLQ-OG25 questionnaires to evaluate quality of life during the period of January 2014 – December 2017. EORTC QLQ-INFO25 quality of life questionnaire was used to evaluate information needs of patients in both groups. All answers with a long follow up (&gt; 1 year) after surgery were analysed. Results In the McK group 62 and in the IL group 110 patients were included. Median follow up was 3 years for McK and 2 years for IL. Median age was 62,4 years. Cognitive functioning was significantly better in the IL group (P = 0.038). Complaints of dyspnoe (P = 0.004) and dysphagia (P = 0.028) were significantly higher in the McK group. Patients after IL had significantly less trouble with eating with others (P = 0.003), trouble with taste (P = 0.032), chocking when swallowing (P = 0.022) and trouble with talking (P = 0.038). There was no significant difference in global health status or physical, role, social or emotional functioning. Furthermore there was no difference in symptoms of nausea, fatigue, pain, discomfort or information scores between McK and IL groups. Conclusion After a follow up of &gt; 1 year no differences in global health status or physical, role, social or emotional functioning scales between McK and IL esophagectomy were found. However, significant differences in some symptom scales and cognitive functioning were observed in favor of IL. These findings should be taken into consideration when deciding between a McK and IL esophagectomy in patients where both procedures are feasible. Disclosure All authors have declared no conflicts of interest.

PS01.200: OPEN IVOR LEWIS ESOPHAGECTOMY WITH AN AGGRESSIVE UPPER MEDIASTINAL LYMPH NODE DISSECTION

Abstract Background The Ivor Lewis procedure consists of open subtotal esophagectomy and intrathoracic esophago-gastric anastomosis. Though this procedure is open surgery, it can minimize the risk of anastomotic leakage. This procedure combined with aggressive upper mediastinal lymph node dissection could achieve satisfactory short-term and long-term outcomes. Methods The cases with middle or lower thoracic cancer without metastasis at the cervical area are subjected to this Ivor Lewis procedure. To evade the demerit of thoracotomy, we have employed 1) the 3-field lymphadenectomy in selective patients, 2) the vertical muscle-sparing thoracotomy without transection of muscles and ribs, 3) paravertebral block for postoperative pain. Results A total of 246 patients who underwent subtotal esophagectomy (2011.1–2016.12) were analyzed for short-time postoperative outcomes. In 135 patients of the Ivor-Lewis group, prevalence of anastomotic leakage, anastomotic stricture recurrent nerve palsy and the morbidity, defined as Clavien-Dindo classification 2 or further, was 0%, 0.7% and 21% respectively. On the other hand, the incidence of these increased significantly in 111 patients who underwent cervical anastomosis, 10%, 6.3% and 47% respectively. Though Ivor-Lewis was open surgery, 83% patients in the Ivor Lewis group achieved 30 m walking at the ward within postoperative day 2 and the median length of postoperative hospital stay was 16 days (10–83). The survival according to our therapeutic strategy was analyzed in 352 patients who underwent subtotal esophagectomy for thoracic esophageal cancer (2002.1–2012.12). The overall survival was 82.5/83.5/52.1/50.0/32.1% for stage0/I/II/III/IVa (JES10th). The solitary cervical lymph node recurrence was diagnosed in 5 patients of Ivor-Lewis group, but 4 of the patient could be cured by additional cervical lymph node dissection. Conclusion Discussion: Intrathoracic anastomosis could minimize the risk of anastomotic leakage, and consequently the total complication rate could be reduced. The strategy that the cervical lymphadenectomy is performed only through the thoracic cavity in the selected patients was acceptable because of our survival data. Conclusion: Using our Ivor-Lewis procedure for the patients with thoracic esophageal cancer, even the open operation can minimize the risk of complication. Out therapeutic strategy could achieve satisfactory survival results. Disclosure All authors have declared no conflicts of interest.

Mediastinoscopy-assisted esophagectomy for T2 middle and lower thoracic esophageal squamous cell carcinoma patients

BackgroundWe aimed to compare mediastinoscopy-assisted esophagectomy (MAE) with the Ivor Lewis procedure in T2 middle and lower thoracic esophageal carcinoma patients in fields of perioperative complications and overall survival (OS).MethodsThe clinical data of 112 T2 esophageal cancer patients who received MAE (n = 31) or Ivor Lewis procedure (n = 81) from January 2010 to December 2015 were retrospectively analyzed in propensity score analysis. Thirty-eight T2 esophageal cancer patients who underwent MAE (n = 19) and Ivor Lewis procedure (n = 19) were included in this study. The perioperative conditions and OS were analyzed.ResultsThe MAE group showed shorter operation time (143.2 ± 20.6 vs 176.8 ± 31.1 min, P = 0.001), less drainage in 24 h (119.2 ± 235.1 vs 626.3 ± 396.3 mL, P < 0.001), less retention time of thoracic tube (27.8 ± 24.0 vs 101.2 ± 54.6 h, P < 0.001), and less hemorrhage during operation (255.4 ± 159.8 vs 367.4 ± 150.9 mL, P = 0.059) compared with the Ivor Lewis group. Less dissected lymph nodes were detected in the MAE group (12.2 ± 5.4 vs 16.8 ± 5.8, P = 0.044) than in the Ivor Lewis group, especially in the upper mediastinum (1.8 ± 2.1 vs 3.5 ± 2.3, P < 0.001) and middle mediastinum (2.5 ± 2.0 vs 5.3 ± 3.2, P = 0.027). The mean survival time was 59.1 and 53.3 months for the MAE group and Ivor Lewis group, respectively (P = 0.635). The results of Cox regression indicated that the nodal stage (P = 0.016) was an independent prognostic factor and the surgical method was not an independent prognostic factor for these patients (P = 0.290).ConclusionsMAE procedure showed less surgical trauma compared with the Ivor Lewis procedure. The mediastinal lymphadenectomy of T2 esophageal carcinoma patients who underwent MAE was inferior to those who underwent Ivor Lewis procedure. The perioperative complications and OS of the MAE group were no worse than that of the Ivor Lewis group.

Lymph node dissection for Siewert II esophagogastric junction adenocarcinoma: a retrospective study of 136 cases.

To compare the lymph node dissection with the right transthoracic Ivor-Lewis (IL) procedure to that with the left transthoracic (LT) approach for Siewert type II adenocarcinoma of the esophagogastric (AEG) junction. In this study, 136 patients with Siewert type II AEG who met the inclusion criteria underwent surgical resection were divided into the IL (47 cases) and LT (89 cases) groups. The number and frequency of the dissected lymph nodes in each station were compared between the two groups. The IL group had a longer proximal surgical margin (P = 0.000) and more total (P = 0.000), thoracic (P = 0.000), and abdominal lymph nodes (P = 0.000) dissected than the LT group. In general, the IL group had a higher dissection rate in each thoracic lymph node station (P < 0.05) than the LT group. The dissection rates of the hepatic artery, splenic artery and celiac trunk lymph nodes were higher in the IL group than in the LT group (P < 0.05). The lymph node metastasis rate was 78.7% in the IL group, higher than the 61.8% in the LT group (P = 0.045). The right transthoracic IL procedure was demonstrated to be a better application than the LT approach for Siewert type II AEG in terms of the number and frequency of lymph node resections.

Lymph node dissection for Siewert II esophagogastric junction adenocarcinoma: A retrospective study of 3 surgical procedures.

The present study was aimed to investigate the application of right thansthoracic Ivor–Lewis (IL), left transthoracic (LTT), and left thoracoabdominal (LTA) approach in Siewert type II adenocarcinoma of esophagogastric junction (AEG).The data of 196 patients with Siewert type II AEG received surgical resection in our cancer center between January 2014 and April 2016 was retrospectively analyzed. Finally, 136 patients met the inclusion criteria were enrolled in the study and divided into the IL (47 cases), LTT (51 cases), and LTA group (38 cases). Clinical and short-term treatment effects were compared among the 3 groups.The patients with weight loss, diabetes, and heart disease increased in the LTT group (P = 0.054, P = 0.075, and P = 0.063, respectively). Operation time was significantly longest in the IL group (P < 0.001), but the amount of bleeding and tumor size did not significantly differ among the 3 groups (P = 0.176 and P = 0.228, respectively). The IL group had the significantly longest proximal surgical margin (P < 0.001) and most number of total (P < 0.001) and thoracic lymph nodes (P < 0.001) dissected. Both the IL and LTA groups had more abdominal lymph nodes dissected than the LTT group (P < 0.001). In general, the IL and LTT groups had the highest dissection rates of every station of thoracic (P < 0.05) and lower mediastinal lymph nodes (P < 0.05), respectively. The dissection rate of the paracardial, left gastric artery, and gastric lesser curvature lymph nodes did not differ significantly among the 3 groups (P > 0.05), but the dissection rate of the hepatic artery, splenic artery, and celiac trunk lymph nodes was significantly highest in the IL group (P < 0.05). Postoperative hospital stay, perioperative complications, and mortality did not differ significantly among the 3 groups (P > 0.05).Compared with the traditional left transthoracic approach, the Ivor–Lewis approach did not increase the perioperative mortality and complication rates in Siewert type II AEG, but obtained satisfactory length of the proximal surgical margin, and was better than the left transthoracic approach in thoracic and abdominal lymph node dissection. However, the advantages of Ivor–Lewis procedure requires further follow-up and validation through prospective randomized controlled trials.