M. J. Sabra1, h. Xu1, A. D. Cassano1, L. G. Wolfe1, B. Kaplan1, R. D. Shah1 1Virginia Commonwealth University,Surgery,Richmond, VA, USA
Introduction:
The decision to perform an Ivor Lewis or a McKeown technique for esophagectomy is usually based on surgeon’s preference and their comfort level with the two procedures, usually based on their training and personal experience. In this study we aim to compare these 2 approaches.
Methods:
We identified patients who underwent either approaches to esophagectomy in the American College of Surgeons?National Surgical Quality Improvement Project (ACS?NSQIP) database (2005-15). We compared both groups using a bivariate analysis.
Results:
We identified 4283 patients with esophagectomy and divided them into 2 groups based on whether they received a Mckeown (1279; 29.86%) or an Ivor Lewis (3004; 70.14%) esophagectomy. Basic preoperative characteristics including age, race, gender, BMI, hemoglobin, albumin, creatinine, weight loss, comorbidities, and functional status were not different between groups. General surgeons performed 65% of the Mckeown operations vs. only 50% of the Ivor Lewis operations (p <.0001). The Mckeown operation group had a higher mean operative time (415 vs 393 minutes, p <.0001), higher frequency of sepsis (9.61% vs 7.35%, p= .0129), more patients with prolonged intubation (15.31% vs 12.01%, p= 0.0035), higher rate of re-intubation (14.92% vs 11.68%, p=0.0035), and higher re-admission rate (25% vs 20.92%, p=0.0108). The mortality rate and hospital length of stay (LOS) were not different
Conclusion:
Both techniques are comparable in 30-day mortality and LOS. However, McKeown esophagectomy is a longer operation and it is associated with more unplanned intubation, increased difficulty weaning from the ventilator, more sepsis, and higher chance of readmission.
