• Bin Li, Jiaqing Xiang, Yawei Zhang, Hecheng Li, Jie Zhang, Yihua Sun, Hong Hu, Longsheng Miao, Longfei Ma, Xiaoyang Luo, Sufeng Chen, Ting Ye, Yiliang Zhang, Yang Zhang, and Haiquan Chen.
• Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
• JAMA Surg. 2015 Apr 1;150(4):292-8.

ImportanceSweet esophagectomy is performed widely in China, while the Ivor-Lewis procedure, with potential benefit of an extended lymphadenectomy, is limitedly conducted owing to concern for a higher risk for morbidity. Thus, the role of the Ivor-Lewis procedure for thoracic esophageal cancer needs further investigation.ObjectiveTo determine whether Ivor-Lewis esophagectomy is associated with increased postoperative complications compared with the Sweet procedure.Design, Setting, And ParticipantsA randomized clinical trial was conducted from May 2010 to July 2012 at Fudan University Shanghai Cancer Center, Shanghai, China, of 300 patients with resectable squamous cell carcinoma in the middle and lower third of the thoracic esophagus. Intent-to-treat analysis was performed.InterventionsPatients were randomly assigned to receive either the Ivor-Lewis (n = 150) or Sweet (n = 150) esophagectomy.Main Outcomes And MeasuresThe primary outcome of this clinical trial was operative morbidity (any surgical or nonsurgical complications). Secondary outcomes included oncologic efficacy (number of lymph nodes resected and positive lymph nodes), postoperative mortality (30-day and in-hospital mortality), and patient discharge.ResultsResection without macroscopical residual (R0/R1) was achieved in 149 of 150 patients in each group. Although there was no significant difference between the 2 groups regarding the incidence of each single complication, a significantly higher morbidity rate was found in the Sweet group (62 of 150 [41.3%]) than in the Ivor-Lewis group (45 of 150 [30%]) (P = .04). More patients in the Sweet group (8 of 150 [5.3%]) received reoperations than in the Ivor-Lewis group (1 of 150 [0.7%]) (P = .04). The median hospital stay was 18 days in the Sweet group vs 16 days in the Ivor-Lewis group (P = .002). Postoperative mortality rates in the Ivor-Lewis (1 of 150) and Sweet (3 of 150) groups were 0.7% and 2.0%, respectively (P = .25). More lymph nodes were removed during Ivor-Lewis esophagectomy than during the Sweet procedure (22 vs 18, P < .001).Conclusions And RelevanceEarly results of this study demonstrate that the Ivor-Lewis procedure can be performed with lower rates of postoperative complications and more lymph node retrieval. Ivor-Lewis and Sweet esophagectomies are both safe procedures with low operative mortalities.Trial Registrationclinicaltrials.gov Identifier:NCT01047111.

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