Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
Department of Surgery, Martini Ziekenhuis, Groningen, the Netherlands.
Ann Surg. 2023 Apr 1;277(4):619-628. doi: 10.1097/SLA.0000000000005292. Epub 2021 Nov 11.
This study evaluated the nationwide trends in care and accompanied postoperative outcomes for patients with distal esophageal and gastro-esophageal junction cancer.
The introduction of transthoracic esophagectomy, minimally invasive surgery, and neo-adjuvant chemo(radio)therapy changed care for patients with esophageal cancer.
Patients after elective transthoracic and transhiatal esophagectomy for distal esophageal or gastroesophageal junction carcinoma in the Netherlands between 2007-2016 were included. The primary aim was to evaluate trends in both care and postoperative outcomes for the included patients. Additionally, postoperative outcomes after transthoracic and tran-shiatal esophagectomy were compared, stratified by time periods.
Among 4712 patients included, 74% had distal esophageal tumors and 87% had adenocarcinomas. Between 2007 and 2016, the proportion of transthoracic esophagectomy increased from 41% to 81%, and neo-adjuvant treatment and minimally invasive esophagectomy increased from 31% to 96%, and from 7% to 80%, respectively. Over this 10-year period, postoperative outcomes improved: postoperative morbidity decreased from 66.6% to 61.8% ( P = 0.001), R0 resection rate increased from 90.0% to 96.5% (P <0.001), median lymph node harvest increased from 15 to 19 ( P <0.001), and median survival increased from 35 to 41 months ( P = 0.027).
In this nationwide cohort, a transition towards more neo-adju-vant treatment, transthoracic esophagectomy and minimally invasive surgery was observed over a 10-year period, accompanied by decreased postoperative morbidity, improved surgical radicality and lymph node harvest, and improved survival.
本研究评估了全国范围内远端食管和胃食管交界处癌患者的治疗和伴随的术后结果趋势。
经胸食管切除术、微创手术和新辅助化疗（放疗）的引入改变了食管癌患者的治疗方式。
荷兰 2007 年至 2016 年间，对接受择期经胸和经食管裂孔食管切除术治疗远端食管或胃食管交界处癌的患者进行了研究。主要目的是评估纳入患者的治疗和术后结果趋势。此外，还比较了经胸和经食管裂孔食管切除术的术后结果，并按时间段进行了分层。
在纳入的 4712 例患者中，74%的患者患有远端食管肿瘤，87%的患者患有腺癌。2007 年至 2016 年间，经胸食管切除术的比例从 41%增加到 81%，新辅助治疗和微创手术的比例从 31%增加到 96%和 7%增加到 80%。在这 10 年期间，术后结果得到了改善：术后发病率从 66.6%降至 61.8%（P=0.001），R0 切除率从 90.0%增加到 96.5%（P<0.001），中位淋巴结采集量从 15 增加到 19（P<0.001），中位生存时间从 35 个月增加到 41 个月（P=0.027）。
在这项全国性队列研究中，在 10 年期间观察到更多的新辅助治疗、经胸食管切除术和微创手术的转变，同时术后发病率降低，手术根治性和淋巴结采集得到改善，生存时间延长。
