Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.
Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
Ann Surg Oncol. 2022 Dec;29(13):8158-8167. doi: 10.1245/s10434-022-12349-8. Epub 2022 Aug 25.
No population-based studies comparing long-term survival after transhiatal esophagectomy (THE) and transthoracic esophagectomy (TTE) exist. This study aimed to compare the 5-year survival of esophageal cancer patients undergoing THE or TTE in a population-based nationwide setting.
This study included all curatively intended THE and TTE for esophageal cancer in Finland during 1987-2016, with follow-up evaluation until 31 December 2019. Cox proportional hazard models provided hazard ratios (HRs) with 95% confidence intervals (CIs) of 5-year and 90-day mortality. The results were adjusted for age, sex, year of operation, comorbidities, histology, neoadjuvant treatment, and pathologic stage.
A total of 1338 patients underwent THE (n = 323) or TTE (n = 1015). The observed 5-year survival rate was 39.3% after THE and 45.0% after TTE (p = 0.072). In adjusted model 1, THE was not associated with greater 5-year mortality (HR 0.99; 95% CI 0.82-1.20) than TTE. In adjusted model 2, including T stage instead of pathologic stage, the 5-year mortality hazard rates after THE (HR 0.87, 95% CI 0.72-1.05) and TTE were comparable. The 90-day mortality rate for THE was higher than for TTE (adjusted HR 0.72; 95% CI 0.45-1.14). In subgroup analyses, no differences between THE and TTE were observed in Siewert II gastroesophageal junction cancers, esophageal cancers, or pN0 tumors, nor in the comparison of THE and TTE with two-field lymphadenectomy. The sensitivity analysis, including patients with missing patient records, who underwent surgery during 1996-2016 mirrored the main analysis.
This Finnish population-based nationwide study suggests no difference in 5-year or 90-day mortality after THE and TTE for esophageal cancer.
目前尚无基于人群的研究比较经胸食管切除术（TTE）和经食管裂孔食管切除术（THE）后长期生存情况。本研究旨在比较在基于人群的全国范围内，接受 THE 或 TTE 的食管癌患者的 5 年生存率。
本研究纳入了 1987 年至 2016 年间在芬兰接受根治性 THE 和 TTE 治疗的所有食管癌患者，随访至 2019 年 12 月 31 日。Cox 比例风险模型提供了 5 年和 90 天死亡率的风险比（HR）及其 95%置信区间（CI）。结果调整了年龄、性别、手术年份、合并症、组织学、新辅助治疗和病理分期。
共 1338 例患者接受了 THE（n=323）或 TTE（n=1015）。THE 组和 TTE 组的观察 5 年生存率分别为 39.3%和 45.0%（p=0.072）。在调整后的模型 1 中，THE 与 5 年死亡率无显著相关性（HR 0.99；95%CI 0.82-1.20）。在调整后的模型 2 中，包括 T 分期而不是病理分期，THE 组和 TTE 组的 5 年死亡率风险比（HR 0.87，95%CI 0.72-1.05）相似。THE 组的 90 天死亡率高于 TTE 组（调整后的 HR 0.72；95%CI 0.45-1.14）。在亚组分析中，THE 组和 TTE 组在 Siewert II 胃食管交界处癌、食管癌或 pN0 肿瘤以及两种淋巴结清扫术的比较中，均未观察到差异。包括缺失患者记录的患者的敏感性分析，其手术时间为 1996-2016 年，与主要分析结果一致。
本项基于芬兰人群的全国性研究表明，食管癌患者接受 THE 和 TTE 治疗后，5 年或 90 天死亡率无差异。
