Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China.
Cancer Hospital of Shantou University Medical College, Guangdong Province, People's Republic of China.
Ann Surg. 2023 Apr 1;277(4):e777-e784. doi: 10.1097/SLA.0000000000005296. Epub 2021 Nov 11.
To evaluate the long-term and short-term outcomes of MIE compared with OE in localized ESCC patients in real-world settings.
MIE is an alternative to OE, despite the limited evidence regarding its effect on long-term survival.
We recruited 5822 consecutive patients with resectable ESCC in 2 typical high-volume centers in southern and northern China, 1453 of whom underwent MIE. Propensity score-based overlap weighted regression adjusted for multifaceted confounding factors was used to compare outcomes in the MIE and OE groups.
Five-year OS was 62.7% in the MIE group and 57.7% in the OE group. The overlap weighted Cox regression showed slightly better OS in the MIE group (hazard ratio 0.93, 95% confidence interval: 0.82-1.06). Although duration of surgery was longer and treatment cost higher in the MIE group than in the OE group, the number of lymph nodes harvested was larger, the proportion of intraoperative blood transfusions lower, and postoperative complications less in the MIE group. 30-day (risk ratio [RR] 0.77, 0.381.55) and 90-day (RR 0.79, 0.46-1.35) mortality were lower in the MIE group versus the OE group, although not statistically significant. These findings were consistent across different analytic approaches and subgroups, notably in the subset of ESCC patients with large tumors.
MIE can be performed safely with OS comparable to OE for patients with localized ESCC, indicating MIE may be recommended as the primary surgical approach for resectable ESCC in health facilities with requisite technical capacity.
在真实环境中，评估微创食管癌根治术（MIE）与开放食管癌根治术（OE）治疗局限性食管鳞癌（ESCC）患者的长期和短期结局。
尽管关于 MIE 对长期生存影响的证据有限，但 MIE 是 OE 的一种替代方法。
我们招募了来自中国南方和北方 2 家大型中心的 5822 例可切除 ESCC 连续患者，其中 1453 例行 MIE。采用倾向评分重叠加权回归调整多方面混杂因素，比较 MIE 组和 OE 组的结局。
MIE 组的 5 年总生存率（OS）为 62.7%，OE 组为 57.7%。重叠加权 Cox 回归显示 MIE 组的 OS 略好（风险比 0.93，95%置信区间：0.82-1.06）。尽管 MIE 组的手术时间较长，治疗费用较高，但淋巴结清扫数目较多，术中输血比例较低，术后并发症较少。MIE 组的 30 天（风险比 [RR] 0.77，0.38-1.55）和 90 天（RR 0.79，0.46-1.35）死亡率低于 OE 组，但无统计学意义。这些发现与不同的分析方法和亚组一致，特别是在肿瘤较大的 ESCC 患者亚组中。
对于局限性 ESCC 患者，MIE 可以安全进行，OS 与 OE 相当，这表明在具备必要技术能力的医疗机构中，MIE 可作为可切除 ESCC 的主要手术方法推荐。
