Zheng Liang, Zhang Xiaobin, Zhang Lei, Wang Qianyun, Wang Zhonglin
Department of Cardiothoracic Surgery, The First People's Hospital of Changzhou and The Third Affiliated Hospital of Soochow University, Changzhou 213003, China.
Mediastinum. 2019 Sep 2;3:34. doi: 10.21037/med.2019.08.01. eCollection 2019.
Studies in larger populations and long-term outcomes of Mediastinoscopic esophagectomy (ME) were needed. The aim of this study was to report the long-term survival and surgical process for reducing the postoperative complications after ME.
From December 2005 to March 2018, 269 patients diagnosed with esophageal squamous cell carcinoma were participated for ME in our center, while we improved the surgical process in November 1st 2014, clinical data was collected and analyzed.
The overall survival rate after ME was 60.3% at 10-year and 69.2% at 5-year, and the survival curve was markedly associated with T and N stages. N stage resulted in lower survival time, while the median survival was 36 months. After Nov. 2014, the positive rate of lymph nodes around left recurrent laryngeal nerve (LRLN) was increased from 6.7% to 14.5% (P<0.05), and the morbidity of vocal cord paralysis decreased from 9.8% to 3.9% (P<0.05), while the incidence of anastomotic fistula decreased from 15% to 5.3% in ME (P<0.05), compared with the data before Nov. 2014.
ME was an effective surgical method for esophageal cancer. The processes of isolating and marking the LRLN and reinforcing the posterior wall of anastomosis were proved valuable for improvement of postoperative complications.
需要对更大规模人群进行纵隔镜下食管切除术（ME）的研究以及其长期预后情况。本研究的目的是报告ME术后的长期生存率以及为减少术后并发症所采取的手术过程。
2005年12月至2018年3月，269例诊断为食管鳞状细胞癌的患者在本中心接受ME手术，2014年11月1日我们改进了手术过程，并收集分析了临床数据。
ME术后10年总生存率为60.3%，5年为69.2%，生存曲线与T和N分期显著相关。N分期导致生存时间较短，中位生存时间为36个月。2014年11月之后，左侧喉返神经（LRLN）周围淋巴结阳性率从6.7%升至14.5%（P<0.05），声带麻痹发生率从9.8%降至3.9%（P<0.05），同时ME术中吻合口瘘发生率从15%降至5.3%（P<0.05），与2014年11月之前的数据相比。
ME是治疗食管癌的一种有效手术方法。分离和标记LRLN以及加固吻合口后壁的操作被证明对改善术后并发症有价值。
