Effect of preserving the bronchial artery and the azygos arch in McKeown esophagectomy: a systematic review and meta‑analysis.

In patients with esophageal cancer, pulmonary complications such as pneumonia and pleural effusion after esophagectomy are a major concern in terms of the short- and long-term prognosis. The relationship between these postoperative complications and preservation of the bronchial artery and the azygos arch in McKeown esophagectomy is unclear. This meta-analysis was performed to compare short-term outcomes between the preservation group (PG) and the dissection group (DG) of each vessel in McKeown esophagectomy. Studies published prior to December 2024 that compared preservation with dissection of the bronchial artery and azygos vein in patients undergoing McKeown esophagectomy were identified through an electronic literature search. A meta-analysis was performed using a Mantel-Haenszel fixed effects model to calculate odds ratios (ORs) with 95% confidence intervals (CIs). Six studies involving 767 patients met the inclusion criteria. For the bronchial arteries, the incidence of postoperative pneumonia was lower in the PG compared to the DG (OR 0.55; 95% CI, 0.33-0.91). Regarding the azygos vein, the duration of chest tube drainage and hospital stay was shorter in the PG compared to the DG (Mean difference: -1.15; 95% CI, -1.81 to -0.49) and (Mean difference: -0.91; 95% CI, -1.81 to -0.02), respectively. Anastomotic leak, recurrent laryngeal nerve palsy, and the number of dissected mediastinal lymph nodes did not differ significantly between the groups. Preservation of the bronchial arteries and azygos vein in McKeown esophagectomy was associated with individual short-term benefits, contributing to decrease the invasiveness of esophageal cancer surgery.