Clinical evaluation of Ivor-Lewis'- and Sweet'-esophagectomy for lower thoracic esophageal carcinomas

OBJECTIVE: To investigate the distribution of lymph node metastases using Ivor-Lewis'-(IL group) or Sweet'-(SW group) lymphadenectomy for lower thoracic esophageal squamous cell carcinomas, and evaluated the impact of these two types of lymphadenectomy based on N classification. METHODS: Totally 119 patients who were treated surgically with lower thoracic esophageal carcinoma, with Ivor- Lewis' or Sweet' esophagectomy were retrospectively reviewed. The metastases rates of each station lymph node were calculated, the numbers of each station lymph nodes dissected were analyzed. RESULTS: The lymph node dissection number of IL group were significantly higher than that of the SW group C(21±7.7) vs (15.6±9.2) , t = 53.4 , P<0.013, so was the lymph note metastasis rate ( 21.4% vs 17. l%,-x ² = 4.820, P = 0.028), the upper mediastinum and the epigastric lymph node status (15.1% vs 5.6%, 17.6% vs 9.0%,P< 0.05). The Ivor- Lewis' duration of surgery was longer than the Sweet' (185.0 min vs 151. 2 min, t = 34. 8 , P< 0.01). There was no significant difference concerning middle or lower mediastinum lymph node status, the amount of bleeding or the complications postoperatively (P> 0.05). CONCLUSION; Regional lymph node metastasis, especially the upper mediastinum and the epigastric, are key factors for lower thoracic esophageal carcinoma Ivor-Lewis esophagectomy with two-field lymph node dissection, a safe operation for thoracic esophageal carcinoma, can help us resect much more lymph nodes, especially for the dissection of the upper mediastinum and the epigastric regions.