Zhang Xining, Qi Kang, Huang Weiming, Liu Jingwei, Lin Gang, Li Jian
Department of Thoracic Surgery, Peking University Health Science Center, Peking University First Hospital, Beijing, China.
Front Oncol. 2022 Dec 13;12:858660. doi: 10.3389/fonc.2022.858660. eCollection 2022.
Despite superior short-term outcomes, there is considerable debate about the oncological efficacy of the left approach esophagectomy for middle and lower squamous esophageal carcinoma (ESCC). A propensity score-matched retrospective study was conducted to evaluate the left approach's short- and long-term effects.
We recorded data from patients with ESCC who underwent curative resection the left or right approach between January 2010 and December 2015. Propensity score matching (PSM) was performed, and maximally selected rank statistics (MSRS) were utilized to determine the appropriate number of lymph nodes to resect during esophagectomy.
One hundred and forty-eight ESCC patients underwent esophagectomy the right approach, and 108 underwent the left approach esophagectomy. After PSM, the left approach esophagectomy showed statistically significant superiority in operative time and time to oral intake, and there was a trend toward a shorter length of hospital stay. Fewer cervical, upper thoracic, and recurrent laryngeal nerve lymph nodes were harvested the left approach than the right approach; the total number of lymph nodes harvested the left and right approaches was similar. Similar long-term survival outcomes were achieved. MSRS suggested that at least 25 lymph nodes are needed to be resected during esophagectomy to improve survival in N0 patients.
The left approach esophagectomy might facilitate postoperative recovery in patients with middle and lower ESCC. With adequate lymphadenectomy, the left approach esophagectomy might achieve similar long-term outcomes for middle and lower ESCC patients.
尽管左胸入路食管癌切除术治疗中下段食管鳞癌（ESCC）的短期疗效更佳，但对于其肿瘤学疗效仍存在诸多争议。我们开展了一项倾向评分匹配的回顾性研究，以评估左胸入路的短期和长期效果。
我们记录了2010年1月至2015年12月期间接受根治性切除的ESCC患者的数据，这些患者采用左胸或右胸入路。进行倾向评分匹配（PSM），并利用最大选择秩统计量（MSRS）来确定食管癌切除术中合适的淋巴结清扫数目。
148例ESCC患者采用右胸入路行食管癌切除术，108例采用左胸入路行食管癌切除术。PSM后，左胸入路食管癌切除术在手术时间和经口进食时间方面显示出统计学上的显著优势，且住院时间有缩短趋势。左胸入路清扫的颈部、上胸部及喉返神经淋巴结较右胸入路少；左右胸入路清扫的淋巴结总数相似。长期生存结果相似。MSRS提示，食管癌切除术中至少需要清扫25枚淋巴结以提高N0患者的生存率。
左胸入路食管癌切除术可能有助于中下段ESCC患者术后恢复。进行充分的淋巴结清扫后，左胸入路食管癌切除术可能使中下段ESCC患者获得相似的长期疗效。
