Comparing Esophagectomy Morbidity Profile Between Ivor Lewis and McKeown for Esophageal Cancer: A Systematic Review and Meta-Analysis

Abstract

Introduction: Esophagectomy has a crucial role in the treatment of esophageal cancer. Several different surgical techniques have been performed in order to achieve better postsurgical and oncological outcomes. In this systematic review and meta-analysis, we compare two procedures - Ivor Lewis and McKeown - regarding their impact on morbidity. Methods: In March 2021, records from Pubmed, Scopus, Web of Science and ClinicalTrials.gov were retrieved. Eligible studies included articles evaluating morbidity outcomes of Ivor Lewis esophagectomy compared to McKeown esophagectomy in patients with resectable esophageal cancer. Main outcomes were postoperative complications, such as anastomotic leak, recurrent laryngeal nerve palsy, chyle leak, respiratory complications; hospital stay length; reoperation and quality of life. A meta-analysis regarding minimally invasive (MI) esophagectomy was performed, using random-effects model. Results: Sixteen studies with a total of 7339 patients were included in systematic review and eight studies were considered in the meta-analysis, where 3015 patients were enrolled. All the included studies were cohort studies, with a low to moderate risk of bias. The results of the meta-analysis revealed that MIE Ivor-Lewis has a lower incidence of recurrent laryngeal nerve palsy (OR=0.13, 95% CI=0.06-0.31, P= <0.00001), reoperation (OR= 0.60, 95% CI=0.41-0.89, P=0.01), anastomotic leak (OR=0.47, 95% CI=0.28-0.78, P=0.003), and respiratory complications (OR = 0.53, 95% CI = 0.39-0.71, P = <0.0001) when compared to MIE McKeown. There was no statistically significant difference between the two surgical procedures in terms of chyle leak and hospital stay length. Conclusions: Concerning explored outcomes, MI Ivor Lewis is superior to MI McKeown, except for chyle leak and hospital stay length where no difference was found. (c) 2023 Celsius Publishing House. All rights reserved.