Department of Thoracic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 JieFang Rd, Hangzhou, 310009, China.
BMC Cancer. 2019 May 27;19(1):500. doi: 10.1186/s12885-019-5656-7.
To investigate the long-term efficacy of the minimally invasive Ivor Lewis esophagectomy (MIILE) in esophageal squamous cell carcinoma (ESCC) patients, a retrospective comparison of the quality of life (QOL) and survival between patients who underwent MIILE and left transthoracic esophagectomy (Sweet approach) was conducted.
A detailed database search identified 614 patients who underwent MIILE and 243 patients who underwent Sweet esophagectomy between January 2011 and December 2017. After propensity score matching, 216 paired cases were selected for statistical analysis. Survival was evaluated with Kaplan-Meier curves or Cox models.
MIILE was associated with a longer duration, less blood loss and more lymph node dissected than Sweet esophagectomy. MIILE patients suffered from less pain, less frequently developed pneumonia, and had fewer postoperative complications. Additionally, MIILE patients began oral intake earlier and had a shorter postoperative hospital stay, and enhanced recovery of QOL. There was no significant difference between the approaches regarding the recurrence pattern, 2-year and 5-year overall survival (OS) or disease-free survival (DFS), except that patients with tumor-node-metastasis (TNM) stage I in the MIILE group demonstrated superior OS and DFS. Pathological TNM stage and postoperative complications were determined to be independent prognostic factors based on the multivariate analysis.
MIILE is a safe and feasible approach for treating ESCC patients. MIILE approach may provide more postoperative advantages, enhanced QOL improvement, and more favorable long-term survival in early stage patients than the Sweet procedure.
为了探究微创 Ivor Lewis 食管癌切除术（MIILE）治疗食管鳞癌（ESCC）患者的长期疗效，本研究回顾性比较了 MIILE 组与左经胸食管切除术（Sweet 入路）组患者的生活质量（QOL）和生存情况。
详细的数据库检索共纳入了 2011 年 1 月至 2017 年 12 月期间接受 MIILE 手术的 614 例患者和接受 Sweet 手术的 243 例患者。经倾向评分匹配后，选取了 216 对匹配病例进行统计学分析。采用 Kaplan-Meier 曲线或 Cox 模型评估生存情况。
与 Sweet 手术相比，MIILE 手术的手术时间更长、术中出血量更少、清扫的淋巴结更多。MIILE 组患者疼痛程度更低、肺炎发生率更低、术后并发症更少。此外，MIILE 组患者更早开始经口进食、术后住院时间更短、QOL 恢复更快。两种手术方式的复发模式、2 年和 5 年总生存（OS）或无病生存（DFS）差异均无统计学意义，但 MIILE 组中肿瘤-淋巴结-转移（TNM）分期为 I 期的患者 OS 和 DFS 更高。多因素分析结果显示，病理 TNM 分期和术后并发症是独立的预后因素。
MIILE 是治疗 ESCC 患者的一种安全可行的方法。与 Sweet 手术相比，MIILE 手术可能为早期患者提供更多术后优势，改善 QOL，并带来更有利的长期生存。
