M J Sabra1, Y A Alwatari2, L G Wolfe1, A Xu1, B J Kaplan1, A D Cassano1, R D Shah1. 1. Department of Surgery, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA, 23298, USA. 2. Department of Surgery, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA, 23298, USA. yahya.alwatari@vcuhealth.org.
Abstract
OBJECTIVES: Ivor Lewis and McKeown esophagectomy are common techniques to treat esophageal cancer. In this study, we aim to compare these two approaches. METHOD: We used the American College of Surgeons National Surgical Quality Improvement Project database (2005-2017) to compare both techniques using bivariate analysis after propensity matching. RESULTS: We identified 6136 patients with esophagectomy and divided them into 2 groups based on whether they received a McKeown (1676; 27.31%) or an Ivor Lewis (4460; 70.14%) esophagectomy. McKeown esophagectomy was associated with higher rates of superficial surgical site infections (8.02% vs 3.67%, p < 0.001), anastomotic leaks (9.12% vs 7.71%, p = 0.02), prolonged intubation (15.06% vs 10.10%, p < 0.001), re-intubation (15.30% vs 10.34%, p ≤ 0.001), and return to the OR (16.46% vs 11.32%, p < 0.001). The McKeown esophagectomy patients also had longer hospital length of stay (14.5 ± 11.99 vs 13.37 ± 11.8, p = 0.002), higher re-admission rate (21.56% vs 16.87%, p = 0.002), and higher discharges to nursing/rehabilitation institutions (14.06% vs 11.99%, p = 0.004).The mortality rate and positive resection margins were not significantly different. There was a trend toward more utilization of Ivor Lewis esophagectomy over years. CONCLUSION: When compared to Ivor Lewis esophagectomy, McKeown esophagectomy is associated with more unplanned intubation, increased difficulty weaning from the ventilator, incisional surgical site infections, anastomotic leak, and higher length of stay.
OBJECTIVES: Ivor Lewis and McKeown esophagectomy are common techniques to treat esophageal cancer. In this study, we aim to compare these two approaches. METHOD: We used the American College of Surgeons National Surgical Quality Improvement Project database (2005-2017) to compare both techniques using bivariate analysis after propensity matching. RESULTS: We identified 6136 patients with esophagectomy and divided them into 2 groups based on whether they received a McKeown (1676; 27.31%) or an Ivor Lewis (4460; 70.14%) esophagectomy. McKeown esophagectomy was associated with higher rates of superficial surgical site infections (8.02% vs 3.67%, p < 0.001), anastomotic leaks (9.12% vs 7.71%, p = 0.02), prolonged intubation (15.06% vs 10.10%, p < 0.001), re-intubation (15.30% vs 10.34%, p ≤ 0.001), and return to the OR (16.46% vs 11.32%, p < 0.001). The McKeown esophagectomy patients also had longer hospital length of stay (14.5 ± 11.99 vs 13.37 ± 11.8, p = 0.002), higher re-admission rate (21.56% vs 16.87%, p = 0.002), and higher discharges to nursing/rehabilitation institutions (14.06% vs 11.99%, p = 0.004).The mortality rate and positive resection margins were not significantly different. There was a trend toward more utilization of Ivor Lewis esophagectomy over years. CONCLUSION: When compared to Ivor Lewis esophagectomy, McKeown esophagectomy is associated with more unplanned intubation, increased difficulty weaning from the ventilator, incisional surgical site infections, anastomotic leak, and higher length of stay.
Authors: Antonio Ivan Lazzarino; Kamal Nagpal; Alex Bottle; Omar Faiz; Krishna Moorthy; Paul Aylin Journal: Ann Surg Date: 2010-08 Impact factor: 12.969
Authors: Leora I Horwitz; Chohreh Partovian; Zhenqiu Lin; Jacqueline N Grady; Jeph Herrin; Mitchell Conover; Julia Montague; Chloe Dillaway; Kathleen Bartczak; Lisa G Suter; Joseph S Ross; Susannah M Bernheim; Harlan M Krumholz; Elizabeth E Drye Journal: Ann Intern Med Date: 2014-11-18 Impact factor: 25.391
Authors: Andrew M Brown; Michael J Pucci; Adam C Berger; Talar Tatarian; Nathaniel R Evans; Ernest L Rosato; Francesco Palazzo Journal: Surg Endosc Date: 2017-06-22 Impact factor: 4.584
Authors: Elizabeth M Hechenbleikner; Martin A Makary; Daniel V Samarov; Jennifer L Bennett; Susan L Gearhart; Jonathan E Efron; Elizabeth C Wick Journal: J Am Coll Surg Date: 2013-04-11 Impact factor: 6.113
Authors: C K Enestvedt; K A Perry; C Kim; P W McConnell; B S Diggs; A Vernon; R W O'Rourke; J D Luketich; J G Hunter; B A Jobe Journal: Dis Esophagus Date: 2009-06-09 Impact factor: 3.429
Authors: Frans van Workum; Annelijn E Slaman; Mark I van Berge Henegouwen; Suzanne S Gisbertz; Ewout A Kouwenhoven; Marc J van Det; Frits J H van den Wildenberg; Fatih Polat; Misha D P Luyer; Grard A P Nieuwenhuijzen; Camiel Rosman Journal: Ann Surg Date: 2020-01 Impact factor: 12.969
Authors: Henna Saviaro; Jukka Rintala; Joonas H Kauppila; Fredrik Yannopoulos; Sanna Meriläinen; Vesa Koivukangas; Heikki Huhta; Olli Helminen; Juha Saarnio Journal: J Thorac Dis Date: 2021-08 Impact factor: 3.005
Authors: Robert E Merritt; Peter J Kneuertz; Mahmoud Abdel-Rasoul; Desmond M D'Souza; Kyle A Perry Journal: J Cardiothorac Surg Date: 2021-12-06 Impact factor: 1.637