P1.159. Long-Term and Perioperative Outcomes of Ivor-Lewis Single-Incision Minimally Invasive Esophagectomy (SIMIE) for Esophageal Cancer: Comparison With McKeown MIE

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer Minimally invasive esophagectomy has been gradually adopted as an effective surgical option for the treatment of esophageal cancer. However, the optimal surgical approach, including port placement and anastomotic site, remains to be determined. In the present study, we evaluated the perioperative and long-term survival outcomes of single-incision Ivor Lewis minimally invasive esophagectomy with intrathoracic esophagogastrostomy for treating esophageal cancer and compared them with those of tri-incision SIMIE with cervical esophagogastrostomy (McKeown approach). A total of 157 patients underwent Ivor Lewis SIMIE and 396 underwent McKeown SIMIE. Compared with the McKeown group, more patients in the Ivor Lewis group had tumors located in the lower third of the thoracic esophagus (60% vs. 15%) and adenocarcinoma in histology (23.7% vs. 2.3%) (P < 0.001 for both). There was no significant difference in overall or major surgical complications, including anastomotic leakage (7.0% vs. 6.3%, p > 0.05) and pneumonia (10.2% vs. 13.4%, p > 0.05), between the two groups. However, the incidence of vocal cord palsy was significantly lower in the Ivor Lewis group (2.5% vs. 8.1%, p = 0.017). The 3- and 5-year overall survival rates were 48.5% and 42.5% in the Ivor Lewis group and 42.4% and 34.4% in the McKeown group, respectively (p = 0.28). No significant survival differences were also observed among patients after classifying with pathological staging. Ivor Lewis SIMIE with intrathoracic esophagogastrostomy provides comparable perioperative and long-term overall survival outcomes to those performed by McKeown SIMIE with cervical esophagogastrostomy. However, Ivor Lewis SIMIE is associated with a significantly lower incidence of postoperative vocal cord palsy.