Takeda Flavio Roberto, Obregon Carlos de Almeida, Navarro Yasmin Peres, Moura Diogo Turiani Hourneaux, Ribeiro Ulysses, Aissar Sallum Rubens Antonio, Cecconello Ivan
Department of Gastroenterology, University of São Paulo Medical School, São Paulo 05403-000, Brazil.
World J Gastrointest Endosc. 2021 Aug 16;13(8):319-328. doi: 10.4253/wjge.v13.i8.319.
Thoracoscopic esophagectomy is related to an extended lymphadenectomy, and a high number of retrieved lymph nodes, compared to the transhiatal approach; however, its association with an improvement in overall survival (OS) is debatable.
To compare thoracoscopic esophagectomy with transhiatal esophagectomy in patients with adenocarcinoma of the esophagogastric junction (AEGJ) in terms of survival, number of lymph nodes, and complications.
In total, 147 patients with AEGJ were selected retrospectively from 2002 to 2019, and divided into Group A for thoracoscopic esophagectomy, and group B for transhiatal esophagectomy. OS, disease-free survival, postoperative complications, and number of nodes, were similarly evaluated.
One hundred and thirty (88%) were male; the mean age was 64 years. Group A had a mean age of 61.1 years and group B 65.7 years ( = 0.009). Concerning the extent of lymphadenectomy, group A showed a higher number of retrieved lymph nodes (mean of 31.89 ± 8.2 20.73 ± 7; < 0.001), with more perioperative complications, such as hoarseness, surgical site infections, and respiratory complications. Although both groups had similar OS rates, subgroup analysis showed better survival of transthoracic esophagectomy in patients with earlier diseases.
Both methods are safe, having similar morbidity and mortality rates. Transthoracic thoracoscopic esophagectomy allows a more extensive resection of the lymph nodes and may have better oncological outcomes during earlier stages of the disease. Prospective studies are warranted to better evaluate these findings.
与经裂孔手术相比，胸腔镜食管切除术涉及更广泛的淋巴结清扫，且获取的淋巴结数量更多；然而，其与总生存期（OS）改善之间的关联存在争议。
比较胸腔镜食管切除术与经裂孔食管切除术治疗食管胃交界腺癌（AEGJ）患者在生存期、淋巴结数量和并发症方面的差异。
回顾性选取2002年至2019年间共147例AEGJ患者，分为胸腔镜食管切除术的A组和经裂孔食管切除术的B组。对OS、无病生存期、术后并发症和淋巴结数量进行类似评估。
130例（88%）为男性；平均年龄64岁。A组平均年龄61.1岁，B组65.7岁（P = 0.009）。关于淋巴结清扫范围，A组获取的淋巴结数量更多（平均31.89±8.2对20.73±7；P<0.001），围手术期并发症更多，如声音嘶哑、手术部位感染和呼吸并发症。虽然两组的OS率相似，但亚组分析显示，疾病分期较早的患者经胸食管切除术的生存期更好。
两种方法均安全，发病率和死亡率相似。经胸胸腔镜食管切除术可更广泛地切除淋巴结，在疾病早期可能具有更好的肿瘤学结局。需要进行前瞻性研究以更好地评估这些发现。
