Division of Advanced Surgical Science and Technology, Tohoku University School of Medicine, Sendai, Japan.
Ann Surg. 2013 May;257(5):873-85. doi: 10.1097/SLA.0b013e31826c87cd.
Survival and prognostic factors were analyzed in 315 patients with esophageal cancer undergoing thoracoscopic-assisted esophagectomy (TAE). The 5-year survival rate of 57.8% was satisfactory, indicating the oncological feasibility of TAE. Perioperative outcomes affected overall survival in the whole cohort but not in the subgroup treated with 2 endoscopic stages.
To estimate the oncological feasibility of thoracoscopic-assisted esophagectomy (TAE) for esophageal cancer and to clarify the prognostic impact of perioperative factors after TAE.
Favorable perioperative outcomes of TAE versus open surgery have been demonstrated. However, survival data after TAE in a large cohort are limited, and no information on the prognostic influence of perioperative factors after TAE is available.
Prospectively collected data for 315 patients undergoing TAE for esophageal cancer were analyzed. Survival was compared with the Kaplan-Meier analysis and Cox regression analysis between 2 surgical approaches: thoracoscopic and hand-assisted laparoscopic esophagectomy (THLE) and thoracoscopic and open laparotomic esophagectomy (TOE). Factors affecting overall survival were identified with Cox multivariate regression analysis in the whole cohort and the THLE subgroup.
THLE and TOE were performed in 153 and 162 patients, respectively. The overall 5-year survival of the whole cohort was 57.8%, with no difference between the THLE and the TOE group. Multivariate analysis of the 315 patients identified the following prognostic factors: blood loss, blood transfusion, intensive care unit stay, cardiovascular complications, pathological T and N stages, lymphatic invasion, intramural metastasis, and number of metastatic nodes. In the THLE subgroup, cerebral comorbidity, histological subtype, pathological T stage, and number of metastatic nodes were independent prognostic factors.
TAE was oncologically feasible. Perioperative factors affected survival in the whole cohort, but did not in the THLE subgroup. However, the reduced perioperative factor effect in this subgroup would be small because the survival rates of the 2 surgical approaches were equal.
对 315 例行胸腔镜辅助食管切除术 (TAE) 的食管癌患者进行了生存和预后因素分析。5 年生存率为 57.8%，令人满意，表明 TAE 的肿瘤学可行性。整个队列的围手术期结局影响总体生存，但在接受 2 个内镜阶段治疗的亚组中则没有影响。
评估胸腔镜辅助食管切除术 (TAE) 治疗食管癌的肿瘤学可行性，并阐明 TAE 后围手术期因素对预后的影响。
已经证明 TAE 与开放手术相比具有良好的围手术期结果。然而，大量患者接受 TAE 后的生存数据有限，并且尚无 TAE 后围手术期因素对预后影响的信息。
对 315 例行 TAE 治疗食管癌的患者前瞻性收集的数据进行了分析。通过 Kaplan-Meier 分析和 Cox 回归分析比较了两种手术方式：胸腔镜辅助腹腔镜食管切除术 (THLE) 和胸腔镜开腹剖腹食管切除术 (TOE) 之间的生存情况。在整个队列和 THLE 亚组中，使用 Cox 多变量回归分析确定影响总生存的因素。
THLE 和 TOE 分别在 153 例和 162 例患者中进行。整个队列的 5 年总生存率为 57.8%，THLE 组和 TOE 组之间无差异。对 315 例患者的多变量分析确定了以下预后因素：出血量、输血、重症监护病房停留、心血管并发症、病理 T 和 N 期、淋巴管浸润、壁内转移和转移淋巴结数量。在 THLE 亚组中，脑合并症、组织学亚型、病理 T 期和转移淋巴结数量是独立的预后因素。
TAE 在肿瘤学上是可行的。围手术期因素影响整个队列的生存，但在 THLE 亚组中则没有影响。然而，由于两种手术方式的生存率相等，因此该亚组中围手术期因素影响的减少将很小。
