Comparison of the Ivor-Lewis vs McKeown Procedure in Esophageal Cancers: An Updated Meta-Analysis and Systematic Review

Abstract

BackgroundThe Ivor Lewis and McKeown techniques are two established approaches for esophagectomy in the treatment of esophageal cancer. Despite their widespread use, limited direct comparisons exist to assess the efficacy of these techniques across key intraoperative and postoperative outcomes. We performed an updated pooled pairwise meta-analysis to discern the relative benefits and risks associated with each approach.MethodsA systematic search of PubMed, Embase, MEDLINE, and the Cochrane Library through September 2024 was conducted. Eligible studies compared Ivor Lewis and McKeown techniques for esophagectomy. Primary outcomes were 12-month mortality and anastomotic complications; secondary outcomes were number of lymph nodes resected, recurrent laryngeal nerve palsy, pulmonary complications, and chyle-leaked complications.ResultsA total of 9 studies comprising 15 341 patients were included. There were no significant differences in terms of 12-month mortality (OR .89, 95% CI .65 to 1.22, P = .48), the number of lymph nodes resected (MD -1.18, 95% CI -4.51 to 2.16, P = .49), and pulmonary complications (OR .87, 95% CI .61 to 1.24, P = .27). However, Ivor Lewis significantly reduced the incidence of anastomotic leakage (OR .42, 95% CI .18 to .98, P = .050), recurrent laryngeal nerve palsy (OR .13, 95% CI .06 to .27, P < .00001), and chyle-related complications (OR .63, 95% CI .39 to 1.04, P = .05) compared to the McKeown technique.ConclusionThis meta-analysis reveals certain significant advantages in Ivor Lewis, while both maintain similarities in other areas.

Keywords: gastrointestinal; surgical quality; thoracic surgery.