Ivor Lewis minimally invasive oesophagectomy versus McKeown approach: short-term benefits and mid-term equivalence in a randomized trial for oesophageal squamous cell carcinoma.

Abstract

Oesophageal cancer (EC) is a leading cause of cancer-related mortality worldwide. Minimally invasive oesophagectomy (MIE) techniques-such as the Ivor Lewis and McKeown techniques-are widely used to treat mid-lower thoracic oesophageal squamous cell carcinoma (ESCC). However, the comparative efficacy of these techniques remains debated, particularly with respect to mid-term outcomes. This study aimed to compare the short- and mid-term outcomes of Ivor Lewis versus McKeown MIE in patients with mid-lower ESCC. This prospective randomized controlled trial (July 2020 - June 2024) enrolled 272 ESCC patients at a single Chinese centre. The patients were randomized to the Ivor Lewis (n = 136) or McKeown (n = 136) MIE groups at a 1:1 ratio. The primary endpoint was postoperative complications; the secondary endpoints included operative parameters, laboratory biomarkers, and progression-free survival (PFS). Statistical analyses, including Kaplan-Meier survival analysis, were performed using SPSS 29.0 and R 4.4.2. The Ivor Lewis group demonstrated significantly lower complication rates and shorter operative time (median [IQR] 210 [176-240] vs. 285 [245-335] minutes, Mann-Whitney U test, p < 0.001), including the rates of anastomotic leak (8.1 vs. 16.9%, p = 0.03), anastomotic stenosis (6.6% vs. 22.8%, p < 0.001), and recurrent laryngeal nerve injury (0 vs. 3.7%, p = 0.02). Both groups exhibited comparable postoperative inflammatory (WBC and CRP) and nutritional (albumin and prealbumin) laboratory changes. No significant difference in PFS was observed (log-rank p = 0.67). Compared with the McKeown approach, Ivor Lewis MIE yields superior short-term outcomes, including reduced operative time and complications. However, there was no significant difference in mid-term survival (as measured by PFS) between the groups.