What type of study is this?

This is a Human Clinical Trial study (also classified as: RCT).

What question did this study set out to answer?

To compare short- and mid-term outcomes of Ivor Lewis versus McKeown minimally invasive oesophagectomy in patients with mid-lower esophageal squamous cell carcinoma.

December 8, 2025Open Access

Ivor Lewis minimally invasive oesophagectomy versus McKeown approach: short-term benefits and mid-term equivalence in a randomized trial for oesophageal squamous cell carcinoma

Puntos clave

To compare short- and mid-term outcomes of Ivor Lewis versus McKeown minimally invasive oesophagectomy in patients with mid-lower esophageal squamous cell carcinoma.
Prospective randomized controlled trial enrolling 272 patients with esophageal squamous cell carcinoma.
Randomization between Ivor Lewis (n=136) and McKeown (n=136) MIE groups at a 1:1 ratio.
Analysis of postoperative complications, operative parameters, and laboratory biomarkers.
Ivor Lewis group had significantly lower complication rates compared to McKeown.
Operative time was shorter in the Ivor Lewis group with a median of 210 minutes versus 285 minutes for McKeown.
Rates of anastomotic leak were 8.1% for Ivor Lewis and 16.9% for McKeown (p=0.03).
No significant difference in progression-free survival was observed between both groups.

Resumen

Abstract Background Oesophageal cancer (EC) is a leading cause of cancer-related mortality worldwide. Minimally invasive oesophagectomy (MIE) techniques—such as the Ivor Lewis and McKeown techniques—are widely used to treat mid-lower thoracic oesophageal squamous cell carcinoma (ESCC). However, the comparative efficacy of these techniques remains debated, particularly with respect to mid-term outcomes. This study aimed to compare the short- and mid-term outcomes of Ivor Lewis versus McKeown MIE in patients with mid-lower ESCC. Materials and Methods This prospective randomized controlled trial (July 2020 – June 2024) enrolled 272 ESCC patients at a single Chinese centre. The patients were randomized to the Ivor Lewis ( n = 136) or McKeown ( n = 136) MIE groups at a 1:1 ratio. The primary endpoint was postoperative complications; the secondary endpoints included operative parameters, laboratory biomarkers, and progression-free survival (PFS). Statistical analyses, including Kaplan–Meier survival analysis, were performed using SPSS 29.0 and R 4.4.2. Results The Ivor Lewis group demonstrated significantly lower complication rates and shorter operative time (median IQR 210 176–240 vs. 285 245–335 minutes, Mann–Whitney U test, p < 0.001), including the rates of anastomotic leak (8.1 vs. 16.9%, p = 0.03), anastomotic stenosis (6.6% vs. 22.8%, p < 0.001), and recurrent laryngeal nerve injury (0 vs. 3.7%, p = 0.02). Both groups exhibited comparable postoperative inflammatory (WBC and CRP) and nutritional (albumin and prealbumin) laboratory changes. No significant difference in PFS was observed (log-rank p = 0.67). Conclusion Compared with the McKeown approach, Ivor Lewis MIE yields superior short-term outcomes, including reduced operative time and complications. However, there was no significant difference in mid-term survival (as measured by PFS) between the groups. Graphical Abstract

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