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ENGLISH ABSTRACT
Ivor-Lewis手术与Mckeown手术治疗胸中下段食管癌临床疗效比较
袁立功
毛友生
作者及单位信息
·
DOI： 10.3760/cma.j.cn112152-20230713-00010
Comparison of clinical outcomes between Ivor-Lewis and Mckeown esophagectomy for middle or lower esophageal cancer
Yuan Ligong
Mao Yousheng
Authors Info & Affiliations
Yuan Ligong
Department of Thoracic Surgery, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
Mao Yousheng
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
·
DOI： 10.3760/cma.j.cn112152-20230713-00010
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摘要

目的比较胸腹联合食管癌根治术（Ivor-Lewis手术）和颈胸腹三切口食管癌根治术（Mckeown手术）治疗胸中下段食管癌的临床疗效。

方法回顾性分析2015年3月至2018年10月于中国医学科学院肿瘤医院胸外科行Ivor-Lewis或Mckeown食管癌根治手术的716例胸中下段食管癌患者的临床资料，比较2种手术方式的围手术期指标、术后并发症和预后情况。

结果716例患者中，行Ivor-Lewis手术和Mckeown手术的患者分别为135例和581例。Mckeown组和Ivor-Lewis组在淋巴结清扫总数［分别为27枚（19～37枚）和25枚（18～33枚）］、淋巴结清扫总站数［5站（4～7站）和5站（4～5站）］、喉返神经旁淋巴结清扫数［分别为3枚（1～6枚）和0枚（0～3枚）］方面比较，Mckeown组均显著优于Ivor-Lewis组（均 P＜0.05），但Mckeown组喉返神经麻痹发生率（10.7%，62/581）显著高于Ivor-Lewis组（1.5%，2/135， P＜0.001）。Ivor-Lewis组患者1、3、5年生存率（分别为91.0%、70.5%和52.9%）与 Mckeown组比较（分别为89.7%、68.4%和62.4%），差异无统计学意义（ P＞0.05）；Ivor-Lewis组患者1、3、5年无病生存率（分别为77.0%、54.1%和44.0%）与Mckeown组比较（分别为78.3%、59.0%和52.8%），差异无统计学意义（ P＞0.05）。

结论对于胸中下段食管癌，Ivor-Lewis手术和Mckeown手术均具有可行性、安全性和良好的近期疗效和相似的生存率。Ivor-Lewis手术具有更低的喉返神经麻痹发生率，Mckeown手术在淋巴结清扫尤其是喉返神经旁淋巴结清扫方面更具有优势。

食管肿瘤;胸腹联合食管癌根治术;颈胸腹三切口食管癌根治术;疗效
ABSTRACT

ObjectiveTo compare the short-term and long-term clinical effects of Ivor-Lewis and Mckeown esophagectomy in the treatment of middle or lower thoracic esophageal cancer.

MethodsThe clinical data of 716 patients with middle and lower thoracic esophageal cancer who underwent radical resection of Ivor Lewis or McKeown esophageal cancer in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Science from March 2015 to October 2018 were analyzed retrospectively, and the perioperative indicators, postoperative complications and survival of the two surgical methods were compared.

ResultsAmong 716 patients, 135 patients underwent Ivor Lewis esophagectomy and 581 patients underwent McKeown esophagectomy. Mckeown group was significantly superior to Ivor Lewis group in terms of total number of lymph node dissection [median number was 27 (19~37) vs 25(18~33)], total number of lymph node dissection stations [median number was 5(4~7) vs 5(4~5)], and number of lymph nodes dissection along recurrent laryngeal nerve [median number was 3 (1~6) vs 0 (0~3), P＜0.05]. However, the incidence of recurrent laryngeal nerve palsy in Mckeown group was significantly higher than that in Ivor Lewis group [10.7% (62/581) vs 1.5%(2/135), P＜0.001]. There was no significant difference in the 1 -, 3 -, 5-year overall survival between the Ivor Lewis group(91.0%, 70.5%, 52.9%) and the Mckeown group (89.7%, 68.4%, 62.4%, P＞0.05), and there was also no significant difference in the 1 -, 3 -, 5-year disease free survival between the Ivor Lewis group(77.0%, 54.1%, 44.0%) and the Mckeown group (78.3%, 59.0%, 52.8%, P＞0.05).

ConclusionsIvor Lewis esophagectomy and Mckeown esophagectomy are feasible, safe, good short-term efficacy and similar survival rate for middle and lower thoracic esophageal cancer. Ivor Lewis surgery has lower incidence of recurrent laryngeal nerve palsy. Mckeown operation has more advantages in lymph node dissection, especially in lymph node dissection beside the recurrent laryngeal nerve.

Esophageal neoplasms;Ivor-Lewis;Mckeown;Therapeutic effect
Mao Yousheng, Email: mocdef.qabqxrehsyoam
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引用本文

袁立功,毛友生. Ivor-Lewis手术与Mckeown手术治疗胸中下段食管癌临床疗效比较[J]. 中华肿瘤杂志,2025,47(03)：262-268.

DOI:10.3760/cma.j.cn112152-20230713-00010

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食管癌目前位居我国恶性肿瘤发病率第6位，死亡率第5位，是常见恶性肿瘤之一 ［ 1 ］ 。目前，食管癌的治疗仍是以手术治疗为主的综合治疗 ［ 2 ］ 。近几十年食管癌手术方式取得了不断进展与创新。目前常见的食管癌术式包括左开胸一切口食管癌根治术（Sweet手术）、胸腹联合食管癌根治术（Ivor-Lewis手术）和颈胸腹三切口食管癌根治术（Mckeown手术） ［ 3 , 4 , 5 ］ 。虽然食管癌手术取得了长足进步，但仍存在创伤大、手术操作复杂、术后并发症多等问题。本文回顾性分析Ivor-Lewis手术和Mckeown手术治疗胸中下段食管癌的临床疗效以及并发症发生情况，以期为临床医师提供借鉴。
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参考文献
[1]
Zheng RS , Zhang SW , Zeng HM ,et al. Cancer incidence and mortality in China, 2016[J]. J Natl Cancer Cent, 2022,2(1):1-9. DOI: 10.1016/j.jncc.2022.02.002 .
返回引文位置Google Scholar
百度学术
万方数据
[2]
Luketich JD , Alvelo-Rivera M , Buenaventura PO ,et al. Minimally invasive esophagectomy: outcomes in 222 patients[J]. Ann Surg, 2003,238(4):486-494. DOI: 10.1097/01.sla.0000089858.40725.68 .
返回引文位置Google Scholar
百度学术
万方数据
[3]
Sweet RH . Carcinoma of the esophagus and the cardiac end of the stomach immediate and late results of treatment by resection and primary esophagogastric anastomosis[J]. J Am Med Assoc, 1947,135(8):485-490. DOI: 10.1001/jama.1947.02890080015005 .
返回引文位置Google Scholar
百度学术
万方数据
[4]
Lewis I . The surgical treatment of carcinoma of the oesophagus with special reference to a new operation for growths of the middle third[J]. Br J Surg, 1946,34:18-31. DOI: 10.1002/bjs.18003413304 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
McKeown KC . Total three-stage oesophagectomy for cancer of the oesophagus[J]. Br J Surg, 1976,63(4):259-262. DOI: 10.1002/bjs.1800630403 .
返回引文位置Google Scholar
百度学术
万方数据
[6]
Booka E , Takeuchi H , Kikuchi H ,et al. Recent advances in thoracoscopic esophagectomy for esophageal cancer[J]. Asian J Endosc Surg, 2019,12(1):19-29. DOI: 10.1111/ases.12681 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
Xu QL , Li H , Zhu YJ ,et al. The treatments and postoperative complications of esophageal cancer: a review[J]. J Cardiothorac Surg, 2020,15(1):163. DOI: 10.1186/s13019-020-01202-2 .
返回引文位置Google Scholar
百度学术
万方数据
[8]
Lunardi AC , Miranda CS , Silva KM ,et al. Weakness of expiratory muscles and pulmonary complications in malnourished patients undergoing upper abdominal surgery[J]. Respirolo gy , 2012,17(1):108-113. DOI: 10.1111/j.1440-1843.2011.02049.x .
返回引文位置Google Scholar
百度学术
万方数据
[9]
Grotenhuis BA , Wijnhoven BP , Grüne F ,et al. Preoperative risk assessment and prevention of complications in patients with esophageal cancer[J]. J Surg Oncol, 2010,101(3):270-278. DOI: 10.1002/jso.21471 .
返回引文位置Google Scholar
百度学术
万方数据
[10]
Low DE , Kuppusamy MK , Alderson D ,et al. Benchmarking complications associated with esophagectomy[J]. Ann Surg, 2019,269(2):291-298. DOI: 10.1097/SLA.0000000000002611 .
返回引文位置Google Scholar
百度学术
万方数据
[11]
Elliott JA , O'Byrne L , Foley G ,et al. Effect of neoadjuvant chemoradiation on preoperative pulmonary physiology, postoperative respiratory complications and quality of life in patients with oesophageal cancer[J]. Br J Surg, 2019,106(10):1341-1351. DOI: 10.1002/bjs.11218 .
返回引文位置Google Scholar
百度学术
万方数据
[12]
Donohoe CL , Phillips AW . Cancer of the esophagus and esophagogastric junction: an 8th edition staging primer[J]. J Thorac Dis, 2017,9(3):E282-E284. DOI: 10.21037/jtd.2017.03.39 .
返回引文位置Google Scholar
百度学术
万方数据
[13]
Berger AC , Bloomenthal A , Weksler B ,et al. Oncologic efficacy is not compromised, and may be improved with minimally invasive esophagectomy[J]. J Am Coll Surg, 2011,212(4):560-566. DOI: 10.1016/j.jamcollsurg.2010.12.042 .
返回引文位置Google Scholar
百度学术
万方数据
[14]
Fujita H , Kakegawa T , Yamana H ,et al. Lymph node metastasis and recurrence in patients with a carcinoma of the thoracic esophagus who underwent three-field dissection[J]. World J Surg, 1994,18(2):266-272. DOI: 10.1007/BF00294412 .
返回引文位置Google Scholar
百度学术
万方数据
[15]
中国抗癌协会食管癌专业委员会. 食管癌根治术胸部淋巴结清扫中国专家共识(2017版)[J]. 中华消化外科杂志, 2017,16(11):1087-1090. DOI: 10.3760/cma.j.issn.1673-9752.2017.11.001 .
返回引文位置Google Scholar
百度学术
万方数据
[16]
Gockel I , Kneist W , Keilmann A ,et al. Recurrent laryngeal nerve paralysis (RLNP) following esophagectomy for carcinoma[J]. Eur J Surg Oncol, 2005,31(3):277-281. DOI: 10.1016/j.ejso.2004.10.007 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
Pertl L , Zacherl J , Mancusi G ,et al. High risk of unilateral recurrent laryngeal nerve paralysis after esophagectomy using cervical anastomosis[J]. Eur Arch Otorhinolaryngol, 2011,268(11):1605-1610. DOI: 10.1007/s00405-011-1679-7 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Yumoto E , Minoda R , Hyodo M ,et al. Causes of recurrent laryngeal nerve paralysis[J]. Auris Nasus Larynx, 2002,29(1):41-45. DOI: 10.1016/s0385-8146(01)00122-5 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
Baba M , Natsugoe S , Shimada M ,et al. Does hoarseness of voice from recurrent nerve paralysis after esophagectomy for carcinoma influence patient quality of life?[J]. J Am Coll Surg, 1999,188(3):231-236. DOI: 10.1016/s1072-7515(98)00295-6 .
返回引文位置Google Scholar
百度学术
万方数据
[20]
Saeki H , Nakashima Y , Hirose K ,et al. "Energy-less technique" with mini-clips for recurrent laryngeal nerve lymph node dissection in prone thoracoscopic esophagectomy for esophageal cancer[J]. Am J Surg, 2018,216(6):1212-1214. DOI: 10.1016/j.amjsurg.2017.10.033 .
返回引文位置Google Scholar
百度学术
万方数据
[21]
Palanivelu C , Prakash A , Senthilkumar R ,et al. Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position--experience of 130 patients[J]. J Am Coll Surg, 2006,203(1):7-16. DOI: 10.1016/j.jamcollsurg.2006.03.016 .
返回引文位置Google Scholar
百度学术
万方数据
[22]
Fabian T , McKelvey AA , Kent MS ,et al. Prone thoracoscopic esophageal mobilization for minimally invasive esophagectomy[J]. Surg Endosc, 2007,21(9):1667-1670. DOI: 10.1007/s00464-007-9193-0 .
返回引文位置Google Scholar
百度学术
万方数据
[23]
Fabian T , Martin J , Katigbak M ,et al. Thoracoscopic esophageal mobilization during minimally invasive esophagectomy: a head-to-head comparison of prone versus decubitus positions[J]. Surg Endosc, 2008,22(11):2485-2491. DOI: 10.1007/s00464-008-9799-x .
返回引文位置Google Scholar
百度学术
万方数据
[24]
Gelpke H , Grieder F , Decurtins M ,et al. Recurrent laryngeal nerve monitoring during esophagectomy and mediastinal lymph node dissection[J]. World J Surg, 2010,34(10):2379-2382. DOI: 10.1007/s00268-010-0692-0 .
返回引文位置Google Scholar
百度学术
万方数据
[25]
Ikeda Y , Inoue T , Ogawa E ,et al. Recurrent laryngeal nerve monitoring during thoracoscopic esophagectomy[J]. World J Surg, 2014,38(4):897-901. DOI: 10.1007/s00268-013-2362-5 .
返回引文位置Google Scholar
百度学术
万方数据
[26]
Zhong D , Zhou Y , Li Y ,et al. Intraoperative recurrent laryngeal nerve monitoring: a useful method for patients with esophageal cancer [J]. Dis Esophagus, 2014,27(5):444-451. DOI: 10.1111/j.1442-2050.2012.01414.x .
返回引文位置Google Scholar
百度学术
万方数据
[27]
Zhou C , Zhang L , Wang H ,et al. Superiority of minimally invasive oesophagectomy in reducing in-hospital mortality of patients with resectable oesophageal cancer: a meta-analysis[J]. PLoS One, 2015,10(7):e0132889. DOI: 10.1371/journal.pone.0132889 .
返回引文位置Google Scholar
百度学术
万方数据
[28]
van Workum F , van der Maas J , van den Wildenberg FJ ,et al. Improved functional results after minimally invasive esophagectomy: intrathoracic versus cervical anastomosis[J]. Ann Thorac Surg, 2017,103(1):267-273. DOI: 10.1016/j.athoracsur.2016.07.010 .
返回引文位置Google Scholar
百度学术
万方数据
[29]
Singhal S , Kailasam A , Akimoto S ,et al. Simple technique of circular stapled anastomosis in ivor lewis esophagectomy[J]. J Laparoendosc Adv Surg Tech A, 2017,27(3):288-294. DOI: 10.1089/lap.2016.0443 .
返回引文位置Google Scholar
百度学术
万方数据
[30]
Seesing MFJ , Gisbertz SS , Goense L ,et al. A propensity score matched analysis of open versus minimally invasive transthoracic esophagectomy in the netherlands[J]. Ann Surg, 2017,266(5):839-846. DOI: 10.1097/SLA.0000000000002393 .
返回引文位置Google Scholar
百度学术
万方数据
[31]
Schmidt HM , Gisbertz SS , Moons J ,et al. Defining benchmarks for transthoracic esophagectomy: a multicenter analysis of total minimally invasive esophagectomy in low risk patients[J]. Ann Surg, 2017,266(5):814-821. DOI: 10.1097/SLA.0000000000002445 .
返回引文位置Google Scholar
百度学术
万方数据
[32]
Fabbi M , Hagens ERC , van Berge Henegouwen MI ,et al. Anastomotic leakage after esophagectomy for esophageal cancer: definitions, diagnostics, and treatment[J]. Dis Esophagus, 2021,34(1):doaa039. DOI: 10.1093/dote/doaa039 .
返回引文位置Google Scholar
百度学术
万方数据
[33]
Verstegen MHP , Slaman AE , Klarenbeek BR ,et al. Outcomes of patients with anastomotic leakage after transhiatal, mckeown or ivor lewis esophagectomy: a nationwide cohort study[J]. World J Surg, 2021,45(11):3341-3349. DOI: 10.1007/s00268-021-06250-w .
返回引文位置Google Scholar
百度学术
万方数据
备注信息
A
毛友生，Email： mocdef.qabqxrehsyoam
B

袁立功：数据收集、文献检索、论文撰写、数据整理、统计学分析、论文修改；毛友生：研究指导、论文修改、经费支持

C
袁立功, 毛友生. Ivor-Lewis手术与Mckeown手术治疗胸中下段食管癌临床疗效比较[J]. 中华肿瘤杂志, 2025, 47(3): 262-268. DOI: 10.3760/cma.j.cn112152-20230713-00010.
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