Two-rope method for dissecting esophagus in McKeown MIE

Area of Science:

• Surgical Oncology
• Thoracic Surgery
• Gastrointestinal Surgery

Background:

• Minimally invasive McKeown esophagectomy (McKeown MIE) is a key treatment for esophageal cancer (EC).
• Current McKeown MIE techniques lack secure and efficient methods for esophageal and lymph node dissection.
• Operative trauma and prolonged procedure times remain challenges in EC treatment.

Purpose of the Study:

• To introduce and evaluate a novel, secure, and feasible esophageal dissection technique for McKeown MIE.
• To compare the efficacy and safety of the "two-rope method" against the regular dissection method in McKeown MIE.
• To assess the impact of the two-rope method on operative time, lymph node dissection, and postoperative complications.

Main Methods:

• Retrospective analysis of 112 patients undergoing McKeown MIE from January 2019 to September 2021.
• Patients were divided into two groups: Group A (45 patients, two-rope method) and Group B (67 patients, regular method).
• Propensity score matching (1:1 nearest neighbor) was used to compare operative time, thoracic operation time, lymph node count, and complications.

Main Results:

• Matched analysis of 41 pairs revealed significantly shorter operation time, thoracic operation time, and smaller abdominal incision size in the two-rope method group (Group A).
• No significant differences were observed in the number of dissected thoracic lymph nodes between the groups.
• Postoperative complications, including pulmonary infection, anastomotic leak, recurrent laryngeal nerve injury, and chylothorax, showed no statistically significant difference.

Conclusions:

• The two-rope method provides significant advantages for esophageal and lymph node dissection in McKeown MIE.
• This technique leads to reduced operative time and smaller incisions compared to the regular method.
• The two-rope method is a feasible and potentially advantageous technique suitable for widespread surgical adoption.