Amsterdam UMC, Department of Surgery, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.
Robotics and Mechatronics, University of Twente, Enschede, The Netherlands.
Ann Surg Oncol. 2021 Jan;28(1):175-183. doi: 10.1245/s10434-020-08760-8. Epub 2020 Jun 30.
Chemoradiation followed by resection has been the standard therapy for resectable (cT1-4aN0-3M0) esophageal carcinoma in the Netherlands since 2010. The optimal surgical approach remains a matter of debate. Therefore, the purpose of this study was to compare the transhiatal and the transthoracic approach concerning morbidity, mortality and oncological quality.
Data was acquired from the Dutch Upper GI Cancer Audit. Patients who underwent esophagectomy with curative intent and gastric tube reconstruction for mid/distal esophageal or esophagogastric junction carcinoma (cT1-4aN0-3M0) from 2011 to 2016 were included. Patients who underwent a transthoracic and transhiatal esophagectomy were compared after propensity score matching.
After propensity score matching, 1532 of 4143 patients were included for analysis. The transthoracic approach yielded more lymph nodes (transthoracic median 19, transhiatal median 14; p < 0.001). There was no difference in the number of positive lymph nodes, however, the median (y)pN-stage was higher in the transthoracic group (p = 0.044). The transthoracic group experienced more chyle leakage (9.7% vs. 2.7%, p < 0.001), more pulmonary complications (35.5% vs. 26.1%, p < 0.001), and more cardiac complications (15.4% vs. 10.3%, p = 0.003). The transthoracic group required a longer hospital stay (median 14 vs. 11 days, p < 0.001), ICU stay (median 3 vs. 1 day, p < 0.001), and had a higher 30-day/in-hospital mortality rate (4.0% vs. 1.7%, p = 0.009).
In a propensity score-matched cohort, the transthoracic esophagectomy provided a more extensive lymph node dissection, which resulted in a higher lymph node yield, at the cost of increased morbidity and short-term mortality.
自 2010 年以来，对于可切除（cT1-4aN0-3M0）食管腺癌，荷兰采用放化疗后切除的标准疗法。最佳手术方法仍存在争议。因此，本研究旨在比较经胸和经食管裂孔两种方法的发病率、死亡率和肿瘤学质量。
从荷兰上消化道癌症审计中获取数据。纳入 2011 年至 2016 年间接受根治性手术和胃管重建的中/下段食管或食管胃交界癌（cT1-4aN0-3M0）患者。对接受经胸和经食管裂孔食管切除术的患者进行倾向评分匹配后进行比较。
经倾向评分匹配后，4143 例患者中有 1532 例纳入分析。经胸入路的淋巴结清扫更为彻底（经胸中位数 19 个，经食管裂孔中位数 14 个；p<0.001）。然而，阳性淋巴结数量没有差异，但经胸组的中位（yp）N 期更高（p=0.044）。经胸组乳糜漏（9.7%比 2.7%，p<0.001）、肺部并发症（35.5%比 26.1%，p<0.001）和心脏并发症（15.4%比 10.3%，p=0.003）更多。经胸组住院时间（中位数 14 天比 11 天，p<0.001）、重症监护病房（中位数 3 天比 1 天，p<0.001）和 30 天/住院死亡率（4.0%比 1.7%，p=0.009）更高。
在倾向评分匹配队列中，经胸食管切除术提供了更广泛的淋巴结清扫，从而获得了更多的淋巴结，但发病率和短期死亡率增加。
