ArticleFrontiers in oncology2026
Comparable outcomes after McKeown and Ivor-Lewis minimally invasive esophagectomy with standardized two-field lymphadenectomy: a propensity score-matched study.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Minimally invasive esophagectomy (MIE) is widely used for esophageal cancer, but the optimal choice between McKeown and Ivor-Lewis MIE remains controversial. This study compared perioperative outcomes and 5-year overall survival (OS) between the two approaches under a standardized two-field lymphadenectomy framework. Methods: We retrospectively reviewed a cohort of 1,011 patients who underwent MIE for esophageal cancer between May 2017 and May 2020. To minimize selection bias, 1:1 propensity score matching (PSM) was performed using the following covariates: age, gender, body mass index(BMI), FEV1%, weight loss, albumin, smoking and drinking history, hypertension, diabetes, coronary heart disease, ASA score, histologic type, tumor location, TNM stage, and neoadjuvant therapy. The primary endpoint was 5-year OS, and the secondary endpoints were perioperative outcomes and postoperative complications. Results: After matching, 542 patients were included, with 271 patients in each group. In the matched cohort, overall postoperative complications were comparable between the McKeown and Ivor-Lewis groups (28.4% vs. 30.6%, P = 0.572), as were Clavien-Dindo grade III or higher complications (18.5% vs. 22.1%, P = 0.286), 30-day mortality (1.5% vs. 1.1%, P = 1.000), and 90-day mortality (2.6% vs. 3.3%, P = 0.612). Five-year OS was 43.5% and 36.2%, respectively, with no significant difference between groups after matching (log-rank P = 0.58). Multivariable Cox analysis showed that surgical approach was not independently associated with OS (Ivor-Lewis vs. McKeown: HR 0.93, 95% CI 0.74-1.16, P = 0.522), whereas prolonged postoperative hospital stay, tumor location, advanced TNM stage, and Clavien-Dindo grade III or higher complications were independently associated with OS. Conclusions: In this real-world propensity score-matched cohort, McKeown and Ivor-Lewis MIE achieved comparable perioperative safety and long-term OS under a standardized two-field lymphadenectomy framework. Long-term prognosis appeared to be more closely associated with tumor stage, tumor location, postoperative hospital stay, and severe postoperative complications than with the surgical approach itself.
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