Comparative evaluation of transmediastinal and minimally invasive McKeown esophagectomy for esophageal cancer: perioperative and oncologic outcomes
BackgroundEsophageal squamous cell carcinoma remains a major health burden in China, where surgical resection is the mainstay of curative therapy. The conventional minimally invasive McKeown esophagectomy (MIE-McKeown), although oncologically effective, entails transthoracic access and single-lung v...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-08-01
|
| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2025.1644505/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849235218908577792 |
|---|---|
| author | Zhichao Ni Zigui Zhu Xin Shi Xi Xia Yan Liu YeHua Cui Yi Zhang Jianxin Zhang |
| author_facet | Zhichao Ni Zigui Zhu Xin Shi Xi Xia Yan Liu YeHua Cui Yi Zhang Jianxin Zhang |
| author_sort | Zhichao Ni |
| collection | DOAJ |
| description | BackgroundEsophageal squamous cell carcinoma remains a major health burden in China, where surgical resection is the mainstay of curative therapy. The conventional minimally invasive McKeown esophagectomy (MIE-McKeown), although oncologically effective, entails transthoracic access and single-lung ventilation, often resulting in higher postoperative morbidity. Thoraco-laparoscopic transmediastinal esophagectomy has emerged as a novel alternative that may mitigate these risks while preserving oncologic integrity.MethodsA retrospective cohort study was conducted involving 268 patients with resectable middle or lower thoracic esophageal squamous cell carcinoma (clinical stage I–III), including 131 who underwent transmediastinal esophagectomy and 137 who received MIE-McKeown. Outcomes assessed included operative time, intraoperative blood loss, lymph node yield, complication profiles, recovery indicators, quality of life (EORTC QLQ-C30), and 6-month disease-free survival (DFS). Statistical comparisons were performed using t-tests, χ² tests, and multivariate logistic regression.ResultsThe transmediastinal esophagectomy group exhibited significantly shorter operative time (197.2 ± 25.9 vs. 286.5 ± 32.1 min, P<0.001) and reduced blood loss (155.4 ± 40.2 vs. 260.7 ± 65.1 mL, P<0.001). Time to oral intake (4.6 ± 1.1 vs. 6.2 ± 1.3 days, P<0.001), drainage duration (3.8 ± 0.5 vs. 4.4 ± 0.7 days, P<0.001), and hospital stay (9.3 ± 1.8 vs. 11.1 ± 2.2 days, P<0.001) were all significantly improved in the transmediastinal esophagectomy group. The incidence of Clavien–Dindo grade ≥III complications was lower (7.6% vs. 16.0%, P=0.043), particularly pneumonia (7.6% vs. 18.2%, P=0.009) and recurrent laryngeal nerve injury (4.6% vs. 11.7%, P=0.031). Lymph node harvest was comparable (21.4 ± 6.2 vs. 22.1 ± 5.9, P=0.344). Three-month quality-of-life scores were higher in the transmediastinal esophagectomy group for global health (73.4 ± 12.1 vs. 66.5 ± 13.4, P=0.005), physical functioning (78.2 ± 11.8 vs. 70.6 ± 13.6, P=0.008), and role functioning (72.1 ± 14.2 vs. 64.3 ± 15.1, P=0.011). The 6-month DFS rates were similar between groups (93.1% vs. 91.2%, log-rank P=0.327).ConclusionsThoraco-laparoscopic transmediastinal esophagectomy is a safe, effective, and minimally invasive alternative to the McKeown approach in selected esophageal squamous cell carcinoma patients. It provides superior perioperative outcomes and enhanced recovery without compromising short-term oncologic efficacy. |
| format | Article |
| id | doaj-art-3cebce2dfd844f6a85fe9fa2a8d02496 |
| institution | Kabale University |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj-art-3cebce2dfd844f6a85fe9fa2a8d024962025-08-20T04:02:51ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-08-011510.3389/fonc.2025.16445051644505Comparative evaluation of transmediastinal and minimally invasive McKeown esophagectomy for esophageal cancer: perioperative and oncologic outcomesZhichao Ni0Zigui Zhu1Xin Shi2Xi Xia3Yan Liu4YeHua Cui5Yi Zhang6Jianxin Zhang7Department of General Thoracic and Cardiovascular Surgery, The Affiliated Nanhua Hospital, Hengyang Medical College, University of South China, Hengyang, Hunan, ChinaIntensive Care Unit, The Affiliated Nanhua Hospital, Hengyang Medical College, University of South China, Hengyang, Hunan, ChinaDepartment of General Surgery, Xupu County Traditional Chinese Medicine Hospital, Huaihua, Hunan, ChinaDepartment of General Thoracic and Cardiovascular Surgery, The Affiliated Nanhua Hospital, Hengyang Medical College, University of South China, Hengyang, Hunan, ChinaDepartment of General Thoracic and Cardiovascular Surgery, The Affiliated Nanhua Hospital, Hengyang Medical College, University of South China, Hengyang, Hunan, ChinaDepartment of General Thoracic and Cardiovascular Surgery, The Affiliated Nanhua Hospital, Hengyang Medical College, University of South China, Hengyang, Hunan, ChinaDepartment of General Thoracic and Cardiovascular Surgery, The Affiliated Nanhua Hospital, Hengyang Medical College, University of South China, Hengyang, Hunan, ChinaDepartment of Thoracic, Cardiac, and Breast Surgery, Changsha Fourth Hospital, Changsha, Hunan, ChinaBackgroundEsophageal squamous cell carcinoma remains a major health burden in China, where surgical resection is the mainstay of curative therapy. The conventional minimally invasive McKeown esophagectomy (MIE-McKeown), although oncologically effective, entails transthoracic access and single-lung ventilation, often resulting in higher postoperative morbidity. Thoraco-laparoscopic transmediastinal esophagectomy has emerged as a novel alternative that may mitigate these risks while preserving oncologic integrity.MethodsA retrospective cohort study was conducted involving 268 patients with resectable middle or lower thoracic esophageal squamous cell carcinoma (clinical stage I–III), including 131 who underwent transmediastinal esophagectomy and 137 who received MIE-McKeown. Outcomes assessed included operative time, intraoperative blood loss, lymph node yield, complication profiles, recovery indicators, quality of life (EORTC QLQ-C30), and 6-month disease-free survival (DFS). Statistical comparisons were performed using t-tests, χ² tests, and multivariate logistic regression.ResultsThe transmediastinal esophagectomy group exhibited significantly shorter operative time (197.2 ± 25.9 vs. 286.5 ± 32.1 min, P<0.001) and reduced blood loss (155.4 ± 40.2 vs. 260.7 ± 65.1 mL, P<0.001). Time to oral intake (4.6 ± 1.1 vs. 6.2 ± 1.3 days, P<0.001), drainage duration (3.8 ± 0.5 vs. 4.4 ± 0.7 days, P<0.001), and hospital stay (9.3 ± 1.8 vs. 11.1 ± 2.2 days, P<0.001) were all significantly improved in the transmediastinal esophagectomy group. The incidence of Clavien–Dindo grade ≥III complications was lower (7.6% vs. 16.0%, P=0.043), particularly pneumonia (7.6% vs. 18.2%, P=0.009) and recurrent laryngeal nerve injury (4.6% vs. 11.7%, P=0.031). Lymph node harvest was comparable (21.4 ± 6.2 vs. 22.1 ± 5.9, P=0.344). Three-month quality-of-life scores were higher in the transmediastinal esophagectomy group for global health (73.4 ± 12.1 vs. 66.5 ± 13.4, P=0.005), physical functioning (78.2 ± 11.8 vs. 70.6 ± 13.6, P=0.008), and role functioning (72.1 ± 14.2 vs. 64.3 ± 15.1, P=0.011). The 6-month DFS rates were similar between groups (93.1% vs. 91.2%, log-rank P=0.327).ConclusionsThoraco-laparoscopic transmediastinal esophagectomy is a safe, effective, and minimally invasive alternative to the McKeown approach in selected esophageal squamous cell carcinoma patients. It provides superior perioperative outcomes and enhanced recovery without compromising short-term oncologic efficacy.https://www.frontiersin.org/articles/10.3389/fonc.2025.1644505/fullesophageal cancertransmediastinal esophagectomyMcKeown procedureminimally invasive surgerysurgical outcomespostoperative complications |
| spellingShingle | Zhichao Ni Zigui Zhu Xin Shi Xi Xia Yan Liu YeHua Cui Yi Zhang Jianxin Zhang Comparative evaluation of transmediastinal and minimally invasive McKeown esophagectomy for esophageal cancer: perioperative and oncologic outcomes Frontiers in Oncology esophageal cancer transmediastinal esophagectomy McKeown procedure minimally invasive surgery surgical outcomes postoperative complications |
| title | Comparative evaluation of transmediastinal and minimally invasive McKeown esophagectomy for esophageal cancer: perioperative and oncologic outcomes |
| title_full | Comparative evaluation of transmediastinal and minimally invasive McKeown esophagectomy for esophageal cancer: perioperative and oncologic outcomes |
| title_fullStr | Comparative evaluation of transmediastinal and minimally invasive McKeown esophagectomy for esophageal cancer: perioperative and oncologic outcomes |
| title_full_unstemmed | Comparative evaluation of transmediastinal and minimally invasive McKeown esophagectomy for esophageal cancer: perioperative and oncologic outcomes |
| title_short | Comparative evaluation of transmediastinal and minimally invasive McKeown esophagectomy for esophageal cancer: perioperative and oncologic outcomes |
| title_sort | comparative evaluation of transmediastinal and minimally invasive mckeown esophagectomy for esophageal cancer perioperative and oncologic outcomes |
| topic | esophageal cancer transmediastinal esophagectomy McKeown procedure minimally invasive surgery surgical outcomes postoperative complications |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2025.1644505/full |
| work_keys_str_mv | AT zhichaoni comparativeevaluationoftransmediastinalandminimallyinvasivemckeownesophagectomyforesophagealcancerperioperativeandoncologicoutcomes AT ziguizhu comparativeevaluationoftransmediastinalandminimallyinvasivemckeownesophagectomyforesophagealcancerperioperativeandoncologicoutcomes AT xinshi comparativeevaluationoftransmediastinalandminimallyinvasivemckeownesophagectomyforesophagealcancerperioperativeandoncologicoutcomes AT xixia comparativeevaluationoftransmediastinalandminimallyinvasivemckeownesophagectomyforesophagealcancerperioperativeandoncologicoutcomes AT yanliu comparativeevaluationoftransmediastinalandminimallyinvasivemckeownesophagectomyforesophagealcancerperioperativeandoncologicoutcomes AT yehuacui comparativeevaluationoftransmediastinalandminimallyinvasivemckeownesophagectomyforesophagealcancerperioperativeandoncologicoutcomes AT yizhang comparativeevaluationoftransmediastinalandminimallyinvasivemckeownesophagectomyforesophagealcancerperioperativeandoncologicoutcomes AT jianxinzhang comparativeevaluationoftransmediastinalandminimallyinvasivemckeownesophagectomyforesophagealcancerperioperativeandoncologicoutcomes |