Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
Ann Surg. 2022 Dec 1;276(6):e749-e757. doi: 10.1097/SLA.0000000000004708. Epub 2020 Dec 23.
This study aimed to compare long-term survival following MIE versus OE for esophageal cancer using a nationwide propensity-score matched cohort.
MIE provides lower postoperative morbidity and mortality, and similar short-term oncological quality compared to OE.
Data was acquired from the Dutch Upper Gastrointestinal Cancer Audit. Patients undergoing minimally invasive or open, transthoracic or transhiatal esophagectomy for primary esophageal cancer between 2011 and 2015 were included. A propensity-score matching analysis for MIE versus OE was performed separately for transthoracic and transhiatal esoph-agectomies.
A total of 1036 transthoracic MIE and OE patients, and 582 transhiatal MIE and OE patients were matched. Long-term survival was comparable for MIE and OE for both transthoracic and transhiatal procedures (5-year overall survival: transthoracic MIE 49.2% vs OE 51.1%, P 0.695; transhiatal MIE 48.4% vs OE 50.7%, P 0.832). For both procedures, MIE yielded more lymph nodes (transthoracic median 21 vs 18, P < 0.001; transhiatal 15 vs 13, P 0.007). Postoperative morbidity was comparable after transthoracic MIE and OE (60.8% vs 64.9%, P 0.177), with a reduced length of stay after transthoracic MIE (median 12 vs 15 days, P < 0.001). After transhiatal MIE, more postoperative complications (64.9% vs 56.4%, P 0.034) were observed, without subsequent difference in length of stay.
Long-term survival after MIE was equivalent to open in both propensity-score matched cohorts of patients undergoing transthoracic or transhiatal esophageal resections. Transhiatal MIE was accompanied withmore postoperative morbidity. Both transthoracic and transhiatal MIE resulted in a more extended lymphadenectomy.
本研究旨在使用全国倾向评分匹配队列比较微创食管癌根治术（MIE）与开放食管癌根治术（OE）治疗食管癌的长期生存情况。
MIE 与 OE 相比，术后发病率和死亡率较低，短期肿瘤学质量相当。
数据来自荷兰上消化道癌症审计。纳入 2011 年至 2015 年间接受微创或开放、经胸或经食管裂孔食管癌切除术的原发性食管癌患者。分别对经胸和经食管裂孔食管癌切除术的 MIE 与 OE 进行倾向评分匹配分析。
共匹配了 1036 例经胸 MIE 和 OE 患者和 582 例经食管裂孔 MIE 和 OE 患者。MIE 和 OE 对经胸和经食管裂孔手术的长期生存情况相当（5 年总生存率：经胸 MIE 为 49.2%，OE 为 51.1%，P=0.695；经食管裂孔 MIE 为 48.4%，OE 为 50.7%，P=0.832）。两种手术方式中，MIE 的淋巴结清扫数目均更多（经胸中位数 21 枚 vs 18 枚，P<0.001；经食管裂孔中位数 15 枚 vs 13 枚，P<0.007）。经胸 MIE 和 OE 的术后发病率相当（60.8% vs 64.9%，P=0.177），经胸 MIE 的住院时间更短（中位数 12 天 vs 15 天，P<0.001）。经食管裂孔 MIE 后，更多的患者出现术后并发症（64.9% vs 56.4%，P=0.034），但随后的住院时间无差异。
在经胸或经食管裂孔食管切除术的两组倾向评分匹配患者中，MIE 的长期生存情况与 OE 相当。经食管裂孔 MIE 术后并发症更多。经胸和经食管裂孔 MIE 均导致淋巴结清扫范围扩大。
