Ivor Lewis And Sweet Approach Analysis And Treatment Of Esophageal Cancer Clinical Evaluation Of Meta Analysis

ObjectiveEsophageal cancer is a high incidence of digestive tractmalignant tumor, statistics in2008the international agency for research on cancer prompt the mortality worldwideannually about40million people. From2003to2007the morbidity of esophageal cancerin China19.34/10million(male25.85/10million, female12.67/10million). Mortality ofesophageal cancer in city area of11.36/10million, mortality of esophageal cancerin rural area is46.64/10million. The mortality rate in China was15.39/10million(male20.71/10million, female9.94/10million), The epidemiological data in184countries and regions display. The incidence and mortality of esophageal cancer China areranked first in the world[1]. The incidence of esophageal cancer ranks the top five ofvarious types of malignant tumors[2]. Prevention and treatment of esophagealmalignancy still needs to be strengthened.Surgical treatment of esophageal cancer has more than100years of history, hasundergone tumor resection, radical resection, extended radical resection andcomprehensive treatment phases. With the development and improvement of medicalstandards, as well as advances in medical technology, operation method of esophagealcancer has gradually diversified way. Diversification of esophageal cancer surgery madesurgeons have more and more choices.Our country surgeons used to Sweet’esophagectomy[3].In1946Lewis proposed by the operation mode right thorax andabdomen two incisions[4]. Because the Ivor Lewis’esophagectomy more in line with theprinciple of Surgical Oncology, gradually known and applied for our clinicians. Study on clinical evaluation of treatment of the above two kinds of operation path in esophagealcancer surgery hand tight years gradually increased. However, due to differences inexpertise and technology habits of clinicians, surgical path for both advantages anddisadvantages in terms of treatment of esophageal cancer, but also the need for furtherresearch and analysis. This paper intends to use the Systematic Reviews’method, throughthe Ivor Lewis and Sweet path for data collection in the clinical operation for esophagealcancerliterature and conducted Meta analysis. Meta-analysis of the results of theapplication more intuitive form of expression to the forest map, comparing two surgicalpath differences in the clinical treatment of esophageal cancer, in order to provide scientificdata to support surgeons and surgical reference in choosing the path of the.MethodsComputer retrieval PubMed, EMBASE, Cochrane Library, CNKI, CBM, VIP andWanfang database, search about Ivor Lewis and Sweet path treatment of esophageal cancersurgery literature of randomized controlled trials. According to Cochrane Handbook fordata evaluation and analysis, RevMan5.1.7statistical software provided by the CochraneCollaboration Meta-analysis of the data included, for dichotomous variables, theapplication of the relative risk (RR) indicates the effect size, confidence interval (CI) of95%. For continuous variables, the application of mean difference (MD) said that the effectsize, confidence interval (CI) of95%. Differences in the findings using the X2test, whenthe consistency (P>0.1and I2<50%) using a fixed effects model, When the heterogeneityof the included studies have analyzed the sources and subgroup analyzes. If the results ofthe statistical results between studies heterogeneity without clinical heterogeneity, using arandom effects model. If the difference is large heterogeneity, using descriptive analysis.ResultsMeta-analysis showed that: Ivor lewis path compared with the Sweet Path, The totalrate of lymph node dissection:IV=4.13,95%CI:2.83~5.43,Z=4.33(P<0.00001), Astatistically significant difference between the two groups; Abdominal lymph nodedissection rate: IV=0.15,95%CI:-1.28~1.58,Z=0.20(P=0.84), No significant differencebetween the two groups; In the postoperative lymph node metastasis rate:After cleaning theoverall rate of lymph node metastasis: RR=1.12,95%CI:0.90~1.39,Z=1.04(P=0.30), Nosignificant difference between the two groups;Mediastinal lymph node metastasis rate:RR=1.96,95%CI:1.13~3.42,Z=2.39(P=0.02), A statistically significant difference between the two groups;The middle mediastinum lymph node metastasis rate:RR=1.07,95%CI:0.88~1.30,Z=0.64(P=0.52), No significant difference between the twogroups;The lower mediastinum lymph node metastasis rate: RR=1.18,95%CI:1.01~1.38,Z=2.05(P=0.04), A statistically significant difference between the two groups;Abdominallymph node metastasis rate: RR=1.48,95%CI:0.87~2.50, Z=1.45(P=0.15), No significantdifference between the two groups; The total incidence of postoperative complications:RR=0.79,95%CI:0.65~0.96, Z=2.40(P=0.02), A statistically significant differencebetween the two groups; The incidence rate of anastomotic leakage: RR=0.80,95%CI:0.54~1.17, Z=1.16(P=0.25), No significant difference between the two groups; Theincidence rate of pulmonary complications: RR=0.96,95%CI:0.60~1.53,Z=0.17(P=0.86),No significant difference between the two groups; The incidence rate of arrhythmia:RR=0.35,95%CI:0.19~0.65,Z=3.34(P=0.0008),A statistically significant differencebetween the two groups; The incidence rate of chylothorax: RR=1.10,95%CI:0.32~3.84,Z=0.15(P=0.88), No significant difference between the two groups;Theincidence rate of recurrent nerve injury: RR=0.89,95%CI:0.07~11.11,Z=0.09(P=0.93),No significant difference between the two groups;The incidence rate of anastomoticstenosis: RR=0.75,95%CI:0.30~1.92,Z=0.59(P=0.55), No significant difference betweenthe two groups;The incidence rate of incision infection: RR=1.07,95%CI:0.36~3.20,Z=0.12(P=0.90). Perioperative period: The operation time: IV=40.90,95%CI:34.57~47.24,Z=12.66(P<0.00001),A statistically significant difference between the twogroups;Blood loss: IV=-11.52,95%CI:-54.55~31.52,Z=0.52(P=0.60), No significantdifference between the two groups; The average postoperative hospital stay: IV=0.10,95%CI:-2.41~2.60,Z=0.07(P=0.94), No significant difference between the two groups;Thoracic drainage tube time: IV=0.12,95%CI:-0.08~0.34,Z=1.20(P=0.23), No significantdifference between the two groups.Conclusions1. Compared to Ivor Lewis operation path and Sweet operation path, More advantagesin the lymph node dissection. Node metastasis rate in the mediastinum and lowermediastinal lymph nodes, Ivor Lewis operation path higher than that of Sweetpath,Especially in the cleaning of mediastinal region, Meanwhile also indirect evidencethatIvor Lewis operation path in the lymph node dissection more advantages, especially forupper mediastinal lymph node dissection. Although the two groups of patients in long-term survival rate without significant difference,however, Ivor Lewis operation path moreextensive lymph node dissection, can help the next clinical staging and treatment toprovide a more reliable basis, to guide clinical decision making.2. Compared to Ivor Lewis operation path and Sweet operation path, Operation timeis longer than Sweet path. However, there are no differences in the intraoperative bleedingvolume, postoperative average hospital stay and postoperative thoracic closed drainagepulled out of time. Therefore the operation mode of Ivor Lewis did not increase the perioperation period of trauma.3. In the postoperative complication rate, there was no statistically significantdifference between the two groups in Anastomotic fistula, chylothorax, pulmonaryinfection, recurrent laryngeal nerve injury, anastomotic stricture and infection of incisionalwound.4. Compared to Ivor Lewis operation path and Sweet operation path, there wasstatistical significance between the two groups in the arrhythmia; In the total postoperativecomplication rate, Ivor Lewis operation path is less than Sweet operation path.