Efficacy comparison of Sweet versus Ivor-Lewis esophagectomy in the treatment of middle-lower esophageal squamous cell carcinoma.
- Author:
Xiaodong YANG
;
Cheng ZHAN
;
Fenghao SUN
;
Li CHEN
;
Mengkun SHI
;
Wei JIANG
1
;
Qun WANG
Author Information
- Publication Type:Journal Article
- MeSH: Anastomotic Leak; Antineoplastic Protocols; Carcinoma, Squamous Cell; mortality; surgery; Esophageal Neoplasms; mortality; surgery; Esophagectomy; adverse effects; methods; Gastroparesis; etiology; Humans; Incidence; Length of Stay; Lymph Node Excision; statistics & numerical data; Lymph Nodes; Lymphatic Metastasis; Neoplasm Staging; statistics & numerical data; Postoperative Complications; etiology; Recovery of Function; Retrospective Studies; Surgical Wound Infection; etiology; Survival Rate; Treatment Outcome
- From: Chinese Journal of Gastrointestinal Surgery 2016;19(9):979-984
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVETo compare the short-term efficacy and long-term survival between Sweet and Ivor-Lewis esophagectomy for patients with middle-lower esophageal squamous cell carcinoma.
METHODSClinicopathologic data of 1 308 patients with middle-lower esophageal squamous cell carcinoma undergoing Sweet or Ivor-Lewis procedures in our department from January 2007 to December 2014 were retrospectively analyzed, including 1 021 patients of Sweet operation (Sweet group) and 287 patients of Ivor-Lewis operation(Ivor-lewis group). Lymph node clearance, lymphatic metastasis, postoperative complication morbidity and long-term survival were compared between the two groups.
RESULTSThere were no significant differences in baseline data between the two groups(all P>0.05). There were more lymph nodes resected during the Ivor-Lewis procedure compared with the Sweet procedure (20.8 vs.19.3, P=0.030). Compared with Ivor-Lewis group, the incidence of wound infection in Sweet group was significantly lower[(3.2%(33/1 021) vs. 8.0%(23/287), P=0.000]. Sweet group had a significantly lower rate of delayed gastric emptying[1.9%(19/1 021) vs. 5.2%(15/287), P=0.002] and significantly shorter hospital stay (14.7 days vs. 17.2 days, P=0.029). With respect to other postoperative complications, such as pulmonary complications, cardiac events, anastomotic leakage, vocal cord palsy, chylothorax and pyothorax, the differences between the two groups were not statistically significant. The 5-year survival rate was not significantly different between the two group (54.0% vs. 56.9%, P=0.873). Stratified analysis based on TNM staging showed that no significant difference of 5-year survival rate was found between the two groups in stageI( and stageIII( patients (P>0.05), while the 5-year survival rate of stageII( patients in Sweet group was significantly lower than that in Ivor-Lewis group (56.4%% vs. 70.4%, P=0.039).
CONCLUSIONSFor patients with middle-lower esophageal squamous cell carcinoma, Sweet procedure has certain superiority regarding the incidence of wound infection and delayed gastric emptying compared with the Ivor-Lewis procedure. Ivor-Lewis esophagectomy can harvest more lymph nodes. The 5-year survival rate of these two procedures is similar. Sweet procedure is still valuable in clinical practice, especially for stageI( and stageIII( patients, while it requires thorough considerations for stageII( patients.
