The Sweet Approach is Still Worthwhile in Modern Esophagectomy

Background: The Ivor Lewis and Sweet approaches are the two most widely used open transthoracic esophagectomy techniques. We evaluated and compared the therapeutic efficacy of these two approaches to determine the appropriate method to treat middle or lower third esophageal carcinomas.

Methods: We retrospectively reviewed patients who underwent esophagectomy with the Sweet (n=748) and Ivor Lewis (n=167) approaches at Zhongshan Hospital, Fudan University between January 2007 and December 2010. Patients with preoperatively identified superior mediastinal lymph node metastases, high-level lesions (above the carina), and benign tumors were excluded. Perioperative-related indicators and 5-year survival rates were compared between groups.

Results: Compared with the Ivor Lewis approach, the Sweet approach has a shorter operative time (181±71 minutes versus 208±63 minutes; p<0.001), less blood loss (167±71 mL versus 179±87 mL; p=0.043), and a lower incidence of transfusion (8.7% versus 13.8%; p=0.044) and postoperative complications (12.3% versus 20.4%; p=0.002). The Ivor Lewis approach was more likely to result in wound infection (3.2% versus 7.8%; p=0.010) and delayed gastric emptying (1.7% versus 4.7%; p=0.046). There was no significant difference between groups with regard to the number of lymph nodes harvested or total number of patients with lymph node metastases. There was no significant difference in locoregional recurrence, distant recurrence, or 5-year survival between approaches.

Conclusions: The Sweet approach has many advantages for the treatment of middle or lower third esophageal carcinomas. It is a safe, effective, and worthwhile approach in modern thoracic surgery.