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<p> Introduction The optimal surgical approach for lower esophageal squamous cell carcinoma (SCC) remains debated, with limited data comparing McKeown (TTE) and Ivor Lewis (IVL) esophagectomies in this specific population. This study aimed to evaluate both short- and long-term outcomes between these techniques. Materials &amp; Methods In this prospective analysis (2017–2024), 100 patients with lower esophageal SCC (45 IVL, 55 TTE) receiving neoadjuvant therapy followed by surgery were evaluated. Standardized techniques included two-field (IVL) or three-field (TTE) lymphadenectomy. Primary endpoints were overall (OS) and disease-free survival (DFS); secondary endpoints included 30-day morbidity and nodal yield. Results The cohorts demonstrated balanced baseline characteristics. Perioperative outcomes showed comparable overall morbidity rates (26.7% IVL vs. 27.3% TTE), with IVL having numerically lower anastomotic leak rates (4.4% vs. 7.3%) and TTE showing higher vocal cord palsy incidence (3.6% vs. 0%). Lymph node retrieval was similar between groups (17.2 vs. 17.6 nodes). Long-term outcomes revealed equivalent 5-year survival rates (OS: 53.1% IVL vs. 59.1% TTE; DFS: 35.0% vs. 32.0%), with locoregional recurrence being the predominant failure pattern in both arms (15.6% IVL vs. 14.5% TTE). Multivariate analysis identified tumor stage as the primary predictor of outcomes, while surgical approach showed no significant impact on survival. Conclusions For lower esophageal SCC, both IVL and TTE demonstrate similar oncologic efficacy despite technical variations. The choice between procedures should be individualized based on tumor characteristics and surgical expertise rather than anticipated outcome differences.</p>

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McKeown Versus Ivor Lewis Esophagectomy for Lower Esophageal Squamous Cell Carcinoma: A Prospective Comparison of Surgical and Survival Outcomes

  • 期刊论文

  • 发表日期：

    2025年7月1日

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  • Naveen Kumar,
  • Pranjal Banthia,
  • Rohan Kapoor,
  • Sandeep Bhoriwal,
  • Amitabha Mandal,
  • S.V.S. Deo,
  • Chandan Kumar,
  • Sushmita Pathy,
  • Rakesh Garg,
  • Sachidanand Jee Bharti,
  • Chethan R,
  • Abhilasha Mishra,
  • Sunil Kumar

摘要

Introduction The optimal surgical approach for lower esophageal squamous cell carcinoma (SCC) remains debated, with limited data comparing McKeown (TTE) and Ivor Lewis (IVL) esophagectomies in this specific population. This study aimed to evaluate both short- and long-term outcomes between these techniques. Materials & Methods In this prospective analysis (2017–2024), 100 patients with lower esophageal SCC (45 IVL, 55 TTE) receiving neoadjuvant therapy followed by surgery were evaluated. Standardized techniques included two-field (IVL) or three-field (TTE) lymphadenectomy. Primary endpoints were overall (OS) and disease-free survival (DFS); secondary endpoints included 30-day morbidity and nodal yield. Results The cohorts demonstrated balanced baseline characteristics. Perioperative outcomes showed comparable overall morbidity rates (26.7% IVL vs. 27.3% TTE), with IVL having numerically lower anastomotic leak rates (4.4% vs. 7.3%) and TTE showing higher vocal cord palsy incidence (3.6% vs. 0%). Lymph node retrieval was similar between groups (17.2 vs. 17.6 nodes). Long-term outcomes revealed equivalent 5-year survival rates (OS: 53.1% IVL vs. 59.1% TTE; DFS: 35.0% vs. 32.0%), with locoregional recurrence being the predominant failure pattern in both arms (15.6% IVL vs. 14.5% TTE). Multivariate analysis identified tumor stage as the primary predictor of outcomes, while surgical approach showed no significant impact on survival. Conclusions For lower esophageal SCC, both IVL and TTE demonstrate similar oncologic efficacy despite technical variations. The choice between procedures should be individualized based on tumor characteristics and surgical expertise rather than anticipated outcome differences.