Mediastinoscopy-assisted esophagectomy for T2 middle and lower thoracic esophageal squamous cell carcinoma patients

Background: We aimed to compare mediastinoscopy-assisted esophagectomy (MAE) with the Ivor Lewis procedure in T2 middle and lower thoracic esophageal carcinoma patients in fields of perioperative complications and overall survival (OS). Methods: The clinical data of 112 T2 esophageal cancer patients who received MAE (n = 31) or Ivor Lewis procedure (n = 81) from January 2010 to December 2015 were retrospectively analyzed in propensity score analysis. Thirty-eight T2 esophageal cancer patients who underwent MAE (n = 19) and Ivor Lewis procedure (n = 19) were included in this study. The perioperative conditions and OS were analyzed. Results: The MAE group showed shorter operation time (143.2 +/- 20.6 vs 176.8 +/- 31.1 min, P = 0.001), less drainage in 24 h (119.2 +/- 235.1 vs 626.3 +/- 396.3 mL, P < 0.001), less retention time of thoracic tube (27.8 +/- 24.0 vs 101.2 +/- 54.6 h, P < 0.001), and less hemorrhage during operation (255.4 +/- 159.8 vs 367.4 +/- 150.9 mL, P = 0.059) compared with the Ivor Lewis group. Less dissected lymph nodes were detected in the MAE group (12.2 +/- 5.4 vs 16.8 +/- 5.8, P = 0.044) than in the Ivor Lewis group, especially in the upper mediastinum (1.8 +/- 2.1 vs 3.5 +/- 2.3, P < 0.001) and middle mediastinum (2.5 +/- 2.0 vs 5.3 +/- 3.2, P = 0.027). The mean survival time was 59.1 and 53.3 months for the MAE group and Ivor Lewis group, respectively (P = 0.635). The results of Cox regression indicated that the nodal stage (P = 0.016) was an independent prognostic factor and the surgical method was not an independent prognostic factor for these patients (P = 0.290). Conclusions: MAE procedure showed less surgical trauma compared with the Ivor Lewis procedure. The mediastinal lymphadenectomy of T2 esophageal carcinoma patients who underwent MAE was inferior to those who underwent Ivor Lewis procedure. The perioperative complications and OS of the MAE group were no worse than that of the Ivor Lewis group.