Department of Thoracic Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong Province, China.
World J Surg. 2010 Feb;34(2):272-6. doi: 10.1007/s00268-009-0341-7.
The aim of this study was to evaluate the therapeutic efficacy of two surgical procedures used to treat middle thoracic esophageal squamous cell carcinoma and compare the results.
A total of 167 patients with middle thoracic esophageal squamous cell carcinoma were included in the study, including 102 patients who underwent Ivor-Lewis esophagectomy and another 65 who underwent dual-incision esophagectomy through the left chest and neck (Dual-incision). The Kaplan-Meier method was used to calculate the survival rate, and Cox regression analysis was performed to identify prognostic risk factors.
Perioperative complications occurred in 35 patients (21%). The incidence rate of recurrent laryngeal nerve injury and anastomotic leakage was higher in the Dual-incision group (p < 0.05), and the incidence rate of gastric retention was higher in the Ivor-Lewis group. However, there were no statistically significant differences. The 3-year local recurrence rate was 37.3% in the Ivor-Lewis group and 40% in the Dual-incision group (p > 0.05). The overall 5-year survival rate was 34.6%; the rates of the Ivor-Lewis group and the Dual-incision group were 36.0 and 32.3%, respectively (p > 0.05). The Cox analysis indicated that the pTNM staging was an independent prognostic risk factor (p = 0.00, hazard ratio = 2.69).
Both Ivor-Lewis esophagectomy and Dual-incision esophagectomy through the left chest and neck are options for treating middle thoracic esophageal squamous cell carcinoma. It is suggested that a patient's individual condition be taken into account when choosing the operative approach.
本研究旨在评估两种用于治疗中段食管鳞癌的手术方法的治疗效果，并对其结果进行比较。
共纳入 167 例中段食管鳞癌患者，其中 102 例行 Ivor-Lewis 食管癌切除术，65 例行左胸颈双切口食管癌切除术（双切口）。采用 Kaplan-Meier 法计算生存率，Cox 回归分析识别预后危险因素。
35 例（21%）患者发生围手术期并发症。双切口组喉返神经损伤和吻合口漏的发生率较高（p<0.05），Ivor-Lewis 组胃潴留的发生率较高，但差异无统计学意义。3 年局部复发率 Ivor-Lewis 组为 37.3%，双切口组为 40%（p>0.05）。总 5 年生存率为 34.6%；Ivor-Lewis 组和双切口组分别为 36.0%和 32.3%（p>0.05）。Cox 分析表明，pTNM 分期是独立的预后危险因素（p=0.00，风险比=2.69）。
Ivor-Lewis 食管癌切除术和左胸颈双切口食管癌切除术均为治疗中段食管鳞癌的可选方法。建议在选择手术方式时应考虑患者的个体情况。
