McKeown Versus Ivor-Lewis Esophagectomy for Patients with a History of Total Pharyngolaryngectomy: A Comparison Study,World Journal of Surgery

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McKeown Versus Ivor-Lewis Esophagectomy for Patients with a History of Total Pharyngolaryngectomy: A Comparison Study
World Journal of Surgery ( IF 2.3 ) Pub Date : 2023-07-11 , DOI: 10.1007/s00268-023-07115-0
Kengo Kuriyama ₁ , Akihiko Okamura ₁ , Yasukazu Kanie ₁ , Suguru Maruyama ₁ , Kei Sakamoto ₁ , Jun Kanamori ₁ , Yu Imamura ₁ , Masayuki Watanabe ₁

Affiliation

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.

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).

Conclusions

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.

中文翻译：

McKeown 与 Ivor-Lewis 食管切除术治疗有咽喉全切除史的患者：一项比较研究

背景

对有全咽喉切除术 (TPL) 病史的患者进行肿瘤食管切除术具有挑战性。有两种不同的食管切除术：全食管切除术加颈部吻合术（McKeown）和次全食管切除术加胸内吻合术（Ivor-Lewis）。对于有此病史的患者，McKeown 和 Ivor-Lewis 食管切除术的结果差异仍不清楚。

方法

我们回顾性分析了 36 名有 TPL 病史并接受肿瘤食管切除术的患者，并比较了不同手术的临床结果。

结果

分别有 12 名 (33.3%) 和 24 名 (66.7%) 患者接受了 McKeown 和 Ivor-Lewis 食管切除术。McKeown 食管切除术更常用于治疗隆突上肿瘤（P = 0.002）。其他基线特征，包括放射治疗史，在各组之间具有可比性。术后，McKeown 组肺炎和吻合口瘘的发生率高于 Ivor-Lewis 组（分别为P = 0.029 和P < 0.001）。未观察到气管坏死和残余食管坏死。各组之间的总生存率和无复发生存率相当（分别为P = 0.494 和P = 0.813）。