微创经左胸入路 Ivor-Lewis 食管癌切除术或胃食管结合部癌切除术：采用倾向评分匹配分析比较术后结果和长期生存。
Minimally Invasive Open Ivor-Lewis Esophagectomy for Esophageal Cancer or Cancer of the Gastroesophageal Junction: Comparison of Postoperative Outcomes and Long-term Survival Using Propensity Score Matching Analysis.
机构信息
Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany;
Department of Visceral Surgery und Medicine, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
出版信息
Anticancer Res. 2021 Jul;41(7):3499-3510. doi: 10.21873/anticanres.15137.
BACKGROUND/AIM: Esophagectomy is crucial for achieving long-term survival in patients with esophageal cancer, while being associated with a significant risk of complications. Aiming to reduce invasiveness and morbidity, total minimal-invasive esophagectomy (MIE) has been gradually implemented worldwide. The aim of the study was to compare MIE to open Ivor-Lewis esophagectomy (OE) for esophageal cancer or cancer of the gastroesophageal junction (GEJ), in terms of postoperative and oncological outcomes.
PATIENTS AND METHODS
Clinicopathological data of patients undergoing oncologic transthoracic esophagectomy (Ivor Lewis procedure) between 2010 and 2019 were assessed. Postoperative outcomes and long-term survival of patients undergoing OE were compared to those after MIE using 1:1 propensity score matching.
RESULTS
After excluding hybrid and robotic procedures, 90 patients who underwent MIE were compared with a matched cohort of 90 patients who underwent OE. MIE was associated with lower major postoperative morbidity (31% vs. 46%, p=0.046) and lower 90-day mortality (2% vs. 12%, p=0.010) compared to OE. MIE showed non-inferior 3-year overall (65% vs. 52%, p=0.019) and comparable disease-free survival rates (49% vs. 51%, p=0.851) in comparison to OE.
CONCLUSION
Our data suggest that MIE should be preferably performed in patients with esophageal cancer or cancer of the GEJ.
背景/目的：食管癌切除术是患者长期生存的关键，但其与并发症风险显著相关。为了降低侵袭性和发病率，全球范围内逐渐采用了全微创食管切除术（MIE）。本研究旨在比较 MIE 与开胸 Ivor-Lewis 食管切除术（OE）治疗食管癌或胃食管交界处（GEJ）癌的术后和肿瘤学结果。
患者和方法
评估了 2010 年至 2019 年间接受经胸根治性食管切除术（Ivor Lewis 手术）的患者的临床病理数据。使用 1:1 倾向评分匹配比较 OE 后患者的术后结果和长期生存情况。
结果
排除杂交和机器人手术后，将 90 例接受 MIE 的患者与 90 例接受 OE 的匹配队列进行比较。与 OE 相比，MIE 与较低的主要术后发病率（31% vs. 46%，p=0.046）和较低的 90 天死亡率（2% vs. 12%，p=0.010）相关。与 OE 相比，MIE 在 3 年总生存率（65% vs. 52%，p=0.019）和无病生存率（49% vs. 51%，p=0.851）方面具有非劣效性。
结论
我们的数据表明，对于食管癌或 GEJ 癌患者，应优先采用 MIE。
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