本研究的目的是比较经胸椎食管切除术(McKeown食管切除术和Ivor-Lewis食管切除术)的5年总生存率。

研究纳入1987年至2016年芬兰所有治疗性食管腺癌或鳞状细胞癌的经胸食管切除术患者，990名患者接受McKeown (n = 278)及Ivor-Lewis (n = 712)食管切除术。并随访至2019年12月31日。Cox比例风险模型提供全因5年死亡率的风险比和95%置信区间。结果根据年龄、性别、手术年份、共病、组织学、分期和新辅助治疗进行调整。调整后的模型还包括肿瘤位置和淋巴结产量。

McKeown和Ivor-Lewis食管切除术后观察到的总5年生存率分别为43.1%和45.9%。与Ivor-Lewis食管切除术相比，McKeown食管切除术与总的5年死亡率无关(校正HR 1.11，95% CI: 0.89-1.38)。对肿瘤位置和淋巴结切除术的额外调整进一步降低点估计值(HR 1.06，95% CI: 0.85-1.33)。手术方式与90天死亡率无关(校正HR 1.15，95% CI: 0.67-1.97)。

Abstract

Objective: The aim of study was to compare overall 5-year survival of esophageal cancer patients undergoing transthoracic esophagectomy with either neck or intrathoracic anastomosis, that is, McKeown and Ivor-Lewis esophagectomy.

Background: No national studies comparing long-term survival after McKeown and ivor-Lewis esophagectomies in the West exist.

Methods: This population-based nationwide study included all curatively intended transthoracic esophagectomies for esophageal adenocarcinoma or squamous cell carcinoma in Finland in 1987 to 2016, with follow-up until December 31, 2019. Cox proportional hazard models provided hazard ratios (HR) with 95% confidence intervals (ci) of all-cause 5-year mortality. The results were adjusted for age, sex, year of the operation, comorbidities, histology, stage, and neoadjuvant treatment. Adjusted model 2 included also tumor location and lymph node yield.

Results: A total of 990 patients underwent McKeown (n = 278) or Ivor-Lewis (n = 712) esophagectomy The observed overall 5-year survival was 43.1% after McKeown, and 45.9% after Ivor-Lewis esophagectomy. McKeown esophagectomy was not associated with the overall 5-year mortality (adjusted HR 1.11, 95% CI: 0.89-1.38), compared to Ivor-Lewis esophagectomy. Additional adjustment for tumor location and lymphadenectomy further attenuated the point estimate (HR 1.06, 95% CI: 0.85-1.33). Surgical approach was not associated with 90-day mortality rate (adjusted HR 1.15, 95% CI: 0.67-1.97).

Conclusions: This population-based nationwide study suggests that overall 5-year survival or 90-day survival with McKeown and Ivor-Lewis esopha-gectomy for esophageal cancer are comparable.

原文链接：

https://www.researchgate.net/publication/338567389_Ivor_Lewis_vs_Mckeown_esophagectomy_analysis_of_operative_outcomes_from_the_ACS_NSQIP_database

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