Our Summary

This research paper is trying to find out which surgery is better for patients with potentially curable cancer in the esophagus or the area where the stomach meets the esophagus, known as the gastro-esophageal junction. The two surgeries in question are Ivor Lewis (IL) and McKeown (McK) esophagectomies. The study looked at patients in the Netherlands who had these surgeries between 2015 and 2017. They made sure to compare patients who were similar in terms of factors like age, sex, type and location of tumor, and overall health.

The main thing they were looking at was how many of these patients were still alive 3 years after their surgery. They also looked at how many lymph nodes were examined and how many were found to contain cancer, how successful the surgery was at removing all the cancer, the degree to which the tumor had shrunk, and complications after surgery.

They found that roughly the same number of patients survived 3 years after surgery whether they had the IL or McK procedure. They also found that the surgeries were similar in terms of how many lymph nodes were examined and found to contain cancer, how successful they were at removing all the cancer, and the degree to which the tumor had shrunk. One difference they did find was that a certain nerve injury happened less often after the IL surgery. There were no differences in other complications or death rates after surgery.

Based on these findings, the researchers concluded that both IL and McK esophagectomies can be used to treat patients with mid to distal esophageal and gastro-esophageal junction cancer.

FAQs

  1. What is the difference in 3-year relative survival rates between Ivor Lewis and McKeown esophagectomy?
  2. Are there any differences in post-operative complications and mortality between Ivor Lewis and McKeown esophagectomy?
  3. Can both Ivor Lewis and McKeown esophagectomy be performed on patients with mid to distal esophageal and gastro-esophageal junction cancer?

Doctor’s Tip

A helpful tip a doctor might tell a patient about esophagectomy is to discuss with their medical team the potential benefits and risks of both Ivor Lewis and McKeown esophagectomy procedures. It is important for patients to understand that both procedures can be effective in treating mid to distal esophageal and GEJ cancer, and to weigh the potential outcomes and complications with their healthcare providers before making a decision.

Suitable For

Patients with mid- and distal esophageal and gastro-esophageal junction (GEJ) cancer without distant metastases are typically recommended esophagectomy. These patients may undergo either Ivor Lewis (IL) or McKeown (McK) esophagectomy, depending on the specific characteristics of their tumor and overall health status. The decision to recommend esophagectomy is typically made by a multidisciplinary team of healthcare providers, including surgeons, oncologists, and other specialists.

Timeline

Before esophagectomy:

  1. Patient is diagnosed with mid- to distal esophageal or GEJ cancer.
  2. Patient undergoes staging tests to determine the extent of the cancer.
  3. Patient may receive neoadjuvant treatment such as chemotherapy or radiation therapy.
  4. Patient undergoes pre-operative evaluation and preparation for surgery.

After esophagectomy:

  1. Patient undergoes either Ivor Lewis or McKeown esophagectomy procedure.
  2. Patient recovers in the hospital for a period of time.
  3. Patient may experience post-operative complications such as anastomotic leakage or pulmonary complications.
  4. Patient undergoes follow-up appointments and surveillance to monitor for recurrence.
  5. Patient may undergo further treatment such as chemotherapy or radiation therapy if necessary.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with esophagectomy surgery?

  2. How will my quality of life be affected after the surgery?

  3. How long is the recovery process after esophagectomy surgery?

  4. What is the expected outcome in terms of survival rates for patients who undergo esophagectomy?

  5. What factors will determine whether I am a candidate for Ivor Lewis or McKeown esophagectomy?

  6. How many surgeries of this type have you performed in the past, and what is your success rate?

  7. Will I require any additional treatments, such as chemotherapy or radiation therapy, after the surgery?

  8. How will my diet and eating habits need to be adjusted after esophagectomy surgery?

  9. Will I need to make any lifestyle changes or modifications after the surgery to prevent complications?

  10. Are there any long-term effects or risks associated with esophagectomy surgery that I should be aware of?

Reference

Authors: Luijten JCHBM, Verstegen MHP, van Workum F, Nieuwenhuijzen GAP, van Berge Henegouwen MI, Gisbertz SS, Wijnhoven BPL, Verhoeven RHA, Rosman C. Journal: Dis Esophagus. 2023 Jul 3;36(7):doac100. doi: 10.1093/dote/doac100. PMID: 36617230