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McKeown Versus Ivor-Lewis Esophagectomy for Patients with a History of Total Pharyngolaryngectomy: A Comparison Study

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Abstract

Background

Oncologic esophagectomy in patients with a history of total pharyngolaryngectomy (TPL) is challenging. There are two different esophagectomy procedures: total esophagectomy with cervical anastomosis (McKeown) and subtotal esophagectomy with intrathoracic anastomosis (Ivor-Lewis). Differences in outcomes between McKeown and Ivor-Lewis esophagectomies for patients with this history remain unclear.

Methods

We retrospectively reviewed 36 patients with a history of TPL who underwent oncologic esophagectomy and compared the clinical outcomes between the procedures.

Results

Twelve (33.3%) and 24 (66.7%) patients underwent McKeown and Ivor-Lewis esophagectomies, respectively. McKeown esophagectomy was more frequently performed for the supracarinal tumors (P = 0.002). Other baseline characteristics, including the history of radiation therapy, were comparable between the groups. Postoperatively, the incidences of pneumonia and anastomotic leakage were higher in the McKeown group than in the Ivor-Lewis group (P = 0.029 and P < 0.001, respectively). Neither tracheal necrosis nor remnant esophageal necrosis was observed. The overall and recurrence-free survival rates were comparable between the groups (P = 0.494 and P = 0.813, respectively).

Conclusions

When performing esophagectomy for patients with a history of TPL, if it is oncologically acceptable and technically available, Ivor-Lewis is preferable over McKeown esophagectomy for avoiding postoperative complications.

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References

  1. Tachimori Y, Watanabe H, Kato H et al (1990) Treatment for synchronous and metachronous carcinomas of the head and neck and esophagus. J Surg Oncol 45:43–45. https://doi.org/10.1002/jso.2930450110

    Article  CAS  PubMed  Google Scholar 

  2. Yoshino K, Endo M, Ishikawa N, Takahashi Y (1995) Diagnosis and treatment of metachronous cancers in the esophagus and the head and neck region. J Surg Oncol 58:246–251. https://doi.org/10.1002/jso.2930580410

    Article  CAS  PubMed  Google Scholar 

  3. Iwatsubo T, Ishihara R, Morishima T et al (2019) Impact of age at diagnosis of head and neck cancer on incidence of metachronous cancer. BMC Cancer 19:3. https://doi.org/10.1186/s12885-018-5231-7

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chung CS, Liao LJ, Wu CY et al (2022) Endoscopic screening for second primary tumors of the esophagus among head and neck cancer patients. Front Oncol 12:906125. https://doi.org/10.3389/fonc.2022.906125

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. van de Ven SEM, de Graaf W, Bugter O et al (2021) Screening for synchronous esophageal second primary tumors in patients with head and neck cancer. Dis Esophagus 34:doab037. https://doi.org/10.1093/dote/doab037

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chung CS, Lo WC, Chen KC et al (2019) Clinical benefits from endoscopy screening of esophageal second primary tumor for head and neck cancer patients: analysis of a hospital-based registry. Oral Oncol 96:27–33. https://doi.org/10.1016/j.oraloncology.2019.06.038

    Article  PubMed  Google Scholar 

  7. Takahashi K, Mine S, Kozuki R et al (2019) Ivor-Lewis esophagectomy for patients with squamous cell carcinoma of the thoracic esophagus with a history of total pharyngolaryngectomy. Esophagus 16:382–385. https://doi.org/10.1007/s10388-019-00677-w

    Article  PubMed  Google Scholar 

  8. Rice TW, Patil DT, Blackstone EH (2017) 8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice. Ann Cardiothorac Surg. 6:119–130. https://doi.org/10.21037/acs.2017.03.14

  9. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2

    Article  PubMed  Google Scholar 

  10. Kitagawa Y, Uno T, Oyama T et al (2019) Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 1. Esophagus 16:1–24. https://doi.org/10.1007/s10388-018-0641-9

    Article  PubMed  Google Scholar 

  11. Kitagawa Y, Uno T, Oyama T et al (2019) Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 2. Esophagus 16:25–43. https://doi.org/10.1007/s10388-018-0642-8

    Article  PubMed  Google Scholar 

  12. van Workum F, Slaman AE, van Berge Henegouwen MI et al (2020) Propensity score-matched analysis comparing minimally invasive Ivor Lewis versus minimally invasive Mckeown esophagectomy. Ann Surg 271:128–133. https://doi.org/10.1097/SLA.0000000000002982

    Article  PubMed  Google Scholar 

  13. van Workum F, Verstegen MHP, Klarenbeek BR et al (2021) Intrathoracic vs cervical anastomosis after totally or hybrid minimally invasive esophagectomy for esophageal cancer: a randomized clinical trial. JAMA Surg 156:601–610. https://doi.org/10.1001/jamasurg.2021.1555

    Article  PubMed  PubMed Central  Google Scholar 

  14. Zhai C, Liu Y, Li W et al (2015) A comparison of short-term outcomes between Ivor-Lewis and McKeown minimally invasive esophagectomy. J Thorac Dis 7:2352–2358. https://doi.org/10.3978/j.issn.2072-1439.2015.12.15

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ishii K, Tsubosa Y, Nakao J et al (2020) Utility of the evaluation of blood flow of remnant esophagus with indocyanine green in esophagectomy with jejunum reconstruction: case series. Ann Med Surg 62:21–25. https://doi.org/10.1016/j.amsu.2020.12.008

    Article  Google Scholar 

  16. van Workum F, Berkelmans GH, Klarenbeek BR, et al (2017) McKeown or Ivor Lewis totally minimally invasive esophagectomy for cancer of the esophagus and gastroesophageal junction: systematic review and meta-analysis. J Thorac Dis 9:S826–S833. https://doi.org/10.21037/jtd.2017.03.173

  17. Schilling MK, Redaelli C, Maurer C, Friess H, Büchler MW (1996) Gastric microcirculatory changes during gastric tube formation: assessment with laser Doppler flowmetry. J Surg Res 62:125–129. https://doi.org/10.1006/jsre.1996.0184

    Article  CAS  PubMed  Google Scholar 

  18. Linder G, Hedberg J, Björck M, Sundbom M (2017) Perfusion of the gastric conduit during esophagectomy. Dis Esophagus 30:143–149. https://doi.org/10.1111/dote.12537

    Article  PubMed  Google Scholar 

  19. Noma K, Shirakawa Y, Kanaya N et al (2018) Visualized evaluation of blood flow to the gastric conduit and complications in esophageal reconstruction. J Am Coll Surg 226:241–251. https://doi.org/10.1016/j.jamcollsurg.2017.11.007

    Article  PubMed  Google Scholar 

  20. Ladak F, Dang JT, Switzer N et al (2019) Indocyanine green for the prevention of anastomotic leaks following esophagectomy: a meta-analysis. Surg Endosc 33:384–394. https://doi.org/10.1007/s00464-018-6503-7

    Article  PubMed  Google Scholar 

  21. Nishikawa K, Fujita T, Yuda M et al (2020) Quantitative assessment of blood flow in the gastric conduit with thermal imaging for esophageal reconstruction. Ann Surg 271:1087–1094. https://doi.org/10.1097/SLA.0000000000003169

    Article  PubMed  Google Scholar 

  22. Watanabe M, Okamura A, Toihata T et al (2018) Recent progress in perioperative management of patients undergoing esophagectomy for esophageal cancer. Esophagus 15:160–164. https://doi.org/10.1007/s10388-018-0617-9

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Editage for English language editing.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan

    Kengo Kuriyama, Akihiko Okamura, Yasukazu Kanie, Suguru Maruyama, Kei Sakamoto, Jun Kanamori, Yu Imamura & Masayuki Watanabe

Authors
  1. Kengo Kuriyama
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  2. Akihiko Okamura
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  3. Yasukazu Kanie
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  4. Suguru Maruyama
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  5. Kei Sakamoto
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  6. Jun Kanamori
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  7. Yu Imamura
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  8. Masayuki Watanabe
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Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by KK and AO. The first draft of the manuscript was written by KK and AO, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Akihiko Okamura.

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Kuriyama, K., Okamura, A., Kanie, Y. et al. McKeown Versus Ivor-Lewis Esophagectomy for Patients with a History of Total Pharyngolaryngectomy: A Comparison Study. World J Surg 47, 2479–2487 (2023). https://doi.org/10.1007/s00268-023-07115-0

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  • DOI: https://doi.org/10.1007/s00268-023-07115-0

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