title: [Short-term efficacy comparison between Ivor-Lewis approach and McKeown approach in minimally invasive esophagectomy].
abstract: OBJECTIVE
  To compare the perioperative complications between Ivor-Lewis approach and McKeown approach in minimally invasive esophagectomy and gastric tube reconstruction for the treatment of middle and lower thoracic esophageal cancer.
  
  
  METHODS
  Retrospective analysis of clinical data was performed on 288 patients with middle and lower thoracic esophageal cancer who underwent completely minimally invasive esophagectomy by one surgical team in Fujian Medical University Union Hospital from December 2010 to March 2014. Among the 288 patients, 103 patients underwent combined laparoscopic and thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis using a transoral anvil(Orvil)(Ivor-Lewis group, 2-incision) and 185 patients underwent combined laparoscopic and thoracoscopic esophagectomy and cervical anastomosis(McKeown group, 3-incision). Patients were stratified by surgical approach and perioperative outcomes were compared between the two groups.
  
  
  RESULTS
  There were no statistical differences between two groups in intra-operative blood loss, conversion to open, extubation time, time to resume oral intake, postoperative hospital stay, the median number of lymph nodes resected. The operation time of Ivor-Lewis group was significantly shorter than that of McKeown group [(283.4±32.0) min vs. (303.6±43.7) min, P=0.003). The hospital cost of Ivor-Lewis group was significantly higher than that of McKeown group [(76 492±18 553) yuan vs. (68 923±17 331) yuan, P<0.01]. There were no statistical differences between two groups in chylothorax, delayed gastric emptying, atrial fibrillation, postoperative bleeding, admission to ICU, short-term postoperative mortality (P>0.05). The total postoperative complication morbidity of Ivor-Lewis group was significantly lower than that of McKeown group(16.5% vs. 31.4%, P<0.01). Ivor-Lewis group had lower pulmonary complication(8.7% vs. 25.9%, P<0.01), anastomotic leakage(1.9% vs. 13.0%, P<0.01), anastomotic stricture (0% vs. 4.9%, P<0.05), recurrent laryngeal nerve injury(1.0% vs. 7.0%, P<0.05).
  
  
  CONCLUSIONS
  Ivor-Lewis approach is associated with less postoperative complications, but higher cost as compared to McKeown approach in the treatment of middle and lower thoracic esophageal cancer.
authors.affiliation: Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China. kangmingqiang@sina.com.
authors.forename: Jihong
authors.initials: J
authors.lastname: Lin
authors.forename: Mingqiang
authors.initials: M
authors.lastname: Kang
authors.forename: Jiangbo
authors.initials: J
authors.lastname: Lin
authors.forename: Shuchen
authors.initials: S
authors.lastname: Chen
authors.forename: Fan
authors.initials: F
authors.lastname: Deng
authors.forename: Wu
authors.initials: W
authors.lastname: Han
authors.forename: Ruobai
authors.initials: R
authors.lastname: Lin
mesh_terms: D000714:Anastomosis, Surgical; D057868:Anastomotic Leak; D016063:Blood Loss, Surgical; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061646:Operative Time; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies