title: Comparison of Ivor-Lewis vs Sweet esophagectomy for esophageal squamous cell carcinoma: a randomized clinical trial.
abstract: OBJECTIVE
  Sweet esophagectomy is performed widely in China, while the Ivor-Lewis procedure, with potential benefit of an extended lymphadenectomy, is limitedly conducted owing to concern for a higher risk for morbidity. Thus, the role of the Ivor-Lewis procedure for thoracic esophageal cancer needs further investigation.
  
  
  OBJECTIVE
  To determine whether Ivor-Lewis esophagectomy is associated with increased postoperative complications compared with the Sweet procedure.
  
  
  METHODS
  A randomized clinical trial was conducted from May 2010 to July 2012 at Fudan University Shanghai Cancer Center, Shanghai, China, of 300 patients with resectable squamous cell carcinoma in the middle and lower third of the thoracic esophagus. Intent-to-treat analysis was performed.
  
  
  METHODS
  Patients were randomly assigned to receive either the Ivor-Lewis (n = 150) or Sweet (n = 150) esophagectomy.
  
  
  METHODS
  The primary outcome of this clinical trial was operative morbidity (any surgical or nonsurgical complications). Secondary outcomes included oncologic efficacy (number of lymph nodes resected and positive lymph nodes), postoperative mortality (30-day and in-hospital mortality), and patient discharge.
  
  
  RESULTS
  Resection without macroscopical residual (R0/R1) was achieved in 149 of 150 patients in each group. Although there was no significant difference between the 2 groups regarding the incidence of each single complication, a significantly higher morbidity rate was found in the Sweet group (62 of 150 [41.3%]) than in the Ivor-Lewis group (45 of 150 [30%]) (P = .04). More patients in the Sweet group (8 of 150 [5.3%]) received reoperations than in the Ivor-Lewis group (1 of 150 [0.7%]) (P = .04). The median hospital stay was 18 days in the Sweet group vs 16 days in the Ivor-Lewis group (P = .002). Postoperative mortality rates in the Ivor-Lewis (1 of 150) and Sweet (3 of 150) groups were 0.7% and 2.0%, respectively (P = .25). More lymph nodes were removed during Ivor-Lewis esophagectomy than during the Sweet procedure (22 vs 18, P < .001).
  
  
  CONCLUSIONS
  Early results of this study demonstrate that the Ivor-Lewis procedure can be performed with lower rates of postoperative complications and more lymph node retrieval. Ivor-Lewis and Sweet esophagectomies are both safe procedures with low operative mortalities.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier:NCT01047111.
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Bin
authors: B
authors: Li
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Jiaqing
authors: J
authors: Xiang
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Yawei
authors: Y
authors: Zhang
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Hecheng
authors: H
authors: Li
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Jie
authors: J
authors: Zhang
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Yihua
authors: Y
authors: Sun
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Hong
authors: H
authors: Hu
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Longsheng
authors: L
authors: Miao
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Longfei
authors: L
authors: Ma
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Xiaoyang
authors: X
authors: Luo
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Sufeng
authors: S
authors: Chen
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Ting
authors: T
authors: Ye
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Yiliang
authors: Y
authors: Zhang
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Yang
authors: Y
authors: Zhang
authors: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Haiquan
authors: H
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002681:China / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome