Comparison Of Therapeutic Effects Between Minimally Invasive McKeown And Open Ivor-Lewis Procedures For Esophageal Cancer Under Different Body Mass Index Categories

Objective:Retrospectively collecting clinical data of patients who underwent surgical treatment for esophageal cancer between January 2015 and December 2020,comparing the short-term efficacy and prognosis of minimally invasive Mc Keow esophageal cancer resection and open Ivor-Lewis esophageal cancer resection under different body mass index,providing certain reference value for the selection of surgical procedures in clinical practice.Methods:The patients who underwent minimally invasive Mc Keown esophageal cancer resection were classified as the MIE group,while those who underwent open Ivor-Lewis esophageal cancer resection were classified as the OE group.The body type grouping was based on the World Health Organization’s classification standards for body mass index（BMI）,dividing patients into two groups:overweight group（BMI≥25 kg/m2）and non-overweight group（BMI<25 kg/m2）.The surgical and body type groups were combined to form four groups.Preoperative data,including medical history,personal history,preoperative examination,age,height,weight,and imaging data,were collected for each patient.Intraoperative data such as operative time,intraoperative blood loss,number of lymph node dissections,and metastasis status were recorded.Postoperative data,including complications,length of hospital stay,extubation time,and drainage fluid,were collected.A surgical complication scoring system was established based on the accordion surgical complication severity grading system,to comprehensively evaluate the incidence and severity of complications.Follow-up was conducted by a dedicated person through outpatient and telephone interviews to investigate the prognosis of different surgical procedures.The data from the four groups of patients were compared to evaluate the short-term efficacy and prognosis of minimally invasive Mc Keown esophageal cancer resection and open Ivor-Lewis esophageal cancer resection at different body mass index levels.Results:Intraoperatively:For both body types,MIE had significantly less blood loss than OE(P₁₂<0.001,P₃₄<0.001).Only in OE,blood loss was greater in overweight patients than in non-overweight patients and this difference was statistically significant（P<0.05）.There was no significant difference in operative time for different BMIs in MIE(P₁₃=0.079),while in OE,high BMI patients had significantly longer operative times(P₂₄<0.001).Non-overweight patients had shorter operative times in OE than in MIE(P₃₄=0.001).There was no significant difference in operative time for overweight patients between MIE and OE(P₁₂=0.270).Postoperatively:Regardless of overweight status,MIE had less chest tube drainage than OE(P₁₂<0.001).In overweight patients,OE had greater chest tube drainage than non-overweight patients(P₂₄=0.029).For all groups,MIE had shorter chest tube removal time than OE(P₁₂<0.001,P₃₄<0.001).MIE had significantly shorter hospital stay than OE(P₁₂<0.001,P₃₄=0.005).There were significant differences among the four groups in terms of postoperative complications in pulmonary infection,pleural effusion,and incision infection（P<0.05）.Among them,in pulmonary infection,there were 26 cases in the overweight OE group,14 cases in the overweight MIE group,11 cases in the non-overweight MIE group,and18 cases in the non-overweight OE group.The incidence of pleural effusion in MIE surgery was significantly less than that in OE surgery.In terms of incision infection,in different BMI,the incidence of incision infection was significantly lower in MIE surgery than in OE surgery.In OE surgery,overweight patients had a higher probability of incision infection.However,there were no significant differences among the four groups in terms of anastomotic fistula,vocal cord paralysis,chylothorax,pulmonary embolism,re-bleeding,and ICU treatment（P>0.05）.Referring to the accordion-style surgical complication severity grading system,a simple complication score was established,and the higher the score,the worse the performance.The complication score of the overweight OE group（193 points）was significantly higher than that of the other groups,with scores of 122 in the overweight MIE group,111 in the non-overweight MIE group,and 130 in the non-overweight OE group.A chi-square test was conducted on the three-year survival rate of the four groups,and the results showed no significant difference in the three-year survival rate among the four groups（P=0.526）.The three-year survival rate of overweight patients（62%）was higher than that of non-overweight patients（55.5%）.It seems that the long-term survival of overweight patients is better.Conclusions:1、For overweight patients with BMI≥25,minimally invasive Mc Keown esophageal cancer resection is preferred,which can effectively reduce the impact of complications on patients.2、For non-overweight patients with BMI<25,there is no significant dvantage between open Ivor-Lewis esophageal cancer resection and minimally invasive Mc Keown esophageal cancer resection,and both can be used.3、Compared to minimally invasive Mc Keown esophagectomy,BMI has greater impact on open Ivor-Lewis esophagectomy,with increased complications and prolonged hospital stay in overweight patients who undergo open Ivor-Lewis.4、Esophageal cancer patients with higher BMI may achieve better ong-term survival results.