Fewer complications with Ivor-Lewis esophagectomy

Last Updated: 2015-02-10

By Will Boggs MD

NEW YORK (Reuters Health) - Ivor-Lewis esophagectomy is associated with fewer complications and more lymph node retrieval, compared with Sweet esophagectomy, researchers from China report.

"Due to some surgeons' concern that Ivor-Lewis procedure is associated with more complications, we hope to give the confirmation that Ivor-Lewis procedure is a safe procedure (and) has the advantage in upper mediastinal lymphadenectomy," Dr. Bin Li, from Fudan University Shanghai Cancer Center, China, told Reuters Health by email.

A few retrospective studies have compared Ivor-Lewis and Sweet esophagectomy, but the relative complications and long-term outcomes remain unclear.

Dr. Li and colleagues, therefore, undertook a clinical trial in which they randomized 300 patients with resectable esophageal squamous cell carcinoma to Ivor-Lewis esophagectomy or Sweet esophagectomy.

Although post-operative mortality did not differ significantly between Ivor-Lewis (0.7%) and Sweet (2.0%) esophagectomy, the morbidity rate was significantly higher after Sweet esophagectomy (62/150, 41.3% vs 45/150, 30%)(p=0.04).

Operating time was significantly longer in the Ivor-Lewis group, whereas hospital stay was significantly longer and reoperations were significantly more common in the Sweet group, according to the February 4 JAMA Surgery online report.

The Ivor-Lewis procedure recovered more lymph nodes in the upper mediastinum and areas around the common hepatic and celiac arteries, but the number of lymph nodes retrieved in the middle/lower esophagus and perigastric regions was similar for the two procedures.

"One limitation of this study was that we did not evaluate postoperative functional status and therefore cannot comment in detail on quality of life following surgery," the researchers note.

"Based on the result, we prefer the Ivor-Lewis procedure, which should be recommended," Dr. Li said. "We still need long-term follow-up to prove the advantage in disease control and survival."

The research was funded by the Key Construction Program of the National 985 Project. The authors report no disclosures.

SOURCE: http://bit.ly/16MPraL

JAMA Surg 2015.