Analysis of the effect of Ivor-Lewis esophagectomy and McKeown esophagectomy on perioperative anxiety and depression in patients with esophageal cancer

Purpose: To compare the effects of Ivor-Lewis esophagectomy and McKeown esophagectomy on perioperative anxiety and depression in patients with esophageal cancer and to analyze the influencing factors. Methods: Sixty-three patients with stage I-III middle and lower esophageal carcinoma who visited the Department of Oncology of the First Affiliated Hospital of Bengbu Medical College from June 2021 to December 2022 were randomly divided into observation group (n = 32) treated with laparoscopic Ivor-Lewis esophagectomy and control group (n = 31) treated with laparoscopic McKeown esophagectomy. The Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS) were administered on the second day following admission and the fifth day after surgery to assess the presence of depression and anxiety. The preoperative and postoperative clinical data of both groups were compared, and multivariate analysis was used to identify risk factors associated with depression and anxiety in patients with esophageal cancer. Results: There were no significant differences in the general clinical data between the two groups before surgery ( P  > 0.05). The incidence of postoperative complications in patients who underwent radical resection of esophageal carcinoma using Ivor-Lewis esophagectomy was significantly lower than that in the McKeown esophagectomy group ( P   0.05). The postoperative SDS and SAS scores in the control group were significantly higher than those before and after operation in the observation group ( P  < 0.01). According to univariate analysis, patients with TNM stage III, tumor diameter greater than 3 cm, postoperative complications, radical McKeown esophagectomy, and C-reactive protein levels above 10 mg/L had a higher incidence of depression and anxiety ( P  < 0.05). Multivariate logistic regression analysis showed that TNM stage III, postoperative complications, surgical approach, and C-reactive protein were all independent factors for depression and anxiety in patients after esophageal cancer surgery ( P  < 0.05). Conclusion: Laparoscopic Ivor-Lewis esophagectomy and McKeown esophagectomy are both effective treatments for middle and lower thoracic esophageal cancer. However, Ivor-Lewis esophagectomy offers significant advantages in preventing complications and improving postoperative recovery efficiency. The Ivor-Lewis esophagectomy has the advantages of fewer complications and low inflammatory response, which can help alleviate anxiety and depression and improve patients' quality of life and prognosis.