Luo Kong-Jia, Fu Jian-Hua, Hu Yi, Rong Tie-Hua, Lin Peng, Wang Xin, Yang Hong, Zheng Bin, Li Yong-Feng
State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060,P. R. China.
Ai Zheng. 2009 Dec;28(12):1260-4. doi: 10.5732/cjc.008.10660.
For squamous cell carcinoma of the middle thoracic esophagus, surgical resection of left or right transthoracic approach has its advantages and disadvantages, respectively. This study was to compare the outcomes between the two approaches.
A total of 482 consecutive patients with middle thoracic esophageal squamous cell carcinoma (ESCC) underwent transthoracic esophagectomy between January 1999 and June 2005. These patients were divided into left transthoracic approach group (n=350) and right transthoracic approach group (n=132). Surgical resection rate, postoperative complications, lymphadenectomy, recurrence pattern, disease-free survival, and overall survival of the two groups were compared retrospectively.
The surgical resection rate was 92.0% in left approach group and 92.4% in right approach group (P=0.878). The incidence of postoperative complications was higher in right approach group than in left approach group (57.6% vs. 35.4%, P<0.001). The average number of lymph nodes resected was 11.8+/-6.6 in left approach group and 16.3+/-8.0 in right approach group (P<0.001). Lymphatic recurrence rate was lower in right approach group than in left approach group (51.1% vs. 69.6%,P=0.028), especially occurring to mediastinal lymph nodes (15.6% vs. 38.4%,P=0.005). Three-year disease-free survival was higher in right approach group than in left approach group(22.92+/-0.74 vs. 25.09+/-1.22, P=0.039).
Although left transthoracic resection reduced the incidence of postoperative complications, esophagectomy of right transthoracic approach was more effective in survival improvement.
对于胸段中段食管癌，经左胸或经右胸手术切除各有优缺点。本研究旨在比较两种手术方式的治疗效果。
1999年1月至2005年6月期间，共有482例连续性胸段中段食管鳞状细胞癌（ESCC）患者接受了经胸段食管切除术。这些患者被分为经左胸手术组（n = 350）和经右胸手术组（n = 132）。回顾性比较两组患者手术切除率、术后并发症、淋巴结清扫情况、复发模式、无病生存率和总生存率等指标。
经左胸手术组手术切除率为92.0%，经右胸手术组为92.4%（P = 0.878）；经右胸手术组术后并发症发生率高于经左胸手术组（57.6% 对35.4%，P <0.001）；经左胸手术组平均切除淋巴结数为11.8 ± 6.6枚，经右胸手术组为16.3 ±8.0枚（P <0.001）；经右胸手术组淋巴转移复发率低于经左胸手术组（51.1% 对69.6%；P =0.028），尤其在纵隔淋巴结转移方面（15.6% 对38.4%；P =0.005）；经右胸手术组三年无病生存率高于经左胸手术组（22.92 ± 0.74对25.09 ± 1.22；P =0.039）。
虽然经左胸手术可降低术后并发症发生率，但经右胸手术切除食管对提高生存率更有效。
