Hong Ziqiang, Gou Wenxi, Lu Yingjie, Wu Xusheng, Sheng Yannan, Cui Baiqiang, Bai Xiangdou, Jin Dacheng, Gou Yunjiu
The First Clinical Medical College of Gansu University of Chinese Medicine, Gansu Provincial Hospital, Lanzhou, China.
Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China.
Front Oncol. 2023 Jan 17;12:1076014. doi: 10.3389/fonc.2022.1076014. eCollection 2022.
To compare the clinical results of the modified Ivor-Lewis procedure, which preserves the azygous vein, thoracic duct and surrounding tissues, with the traditional Ivor-Lewis procedure, which removes these tissues, for treating esophageal squamous cell carcinoma, and evaluating whether the azygous vein, thoracic duct and surrounding tissues are required to be removed for the surgery of esophageal cancer.
To retrospectively analyze the clinical data of patients suffering from esophageal cancer treated by thoracic-laparoscopic Ivor-Lewis procedure admitted to the Department of Thoracic Surgery of Gansu Provincial People's Hospital from September 2017 to September 2019. According to the surgical method, they were divided into the modified thoracolaparoscopic Ivor-Lewis (modified group) and the traditional thoracolaparoscopic Ivor-Lewis (traditional group). Propensity score matching analysis (PSM) was applied to reduce the selection bias of confounding factors.
A total of 245 patients who suffered from esophageal cancer and underwent thoracic-laparoscopic Ivor-Lewis were enrolled in the study. There were 124 cases in the modified group and 121 cases in the traditional group. The discrepancies in the age and T-stage among patients in the traditional and modified groups were statistically significant. After PSM, the above-mentioned factors became statistically insignificant. There were 86 patients in each group after PSM. Compared with the traditional group, the modified group has shorter operative time (=0.007), less intraoperative bleeding (=0.003) and less postoperative 3 days chest drainage(=0.001), with a statistically significant difference. No significant difference in local recurrence (=0.721) and distant metastasis (=0.742) after surgery were found in the two groups, and the difference was not statistically significant. There was also no statistically significant difference in the 3-year postoperative survival rate (44.2% vs. 41.9%, =0.605) between the modified and traditional groups.
The modified Ivor-Lewis procedure, which preserves the azygous vein, thoracic duct, and surrounding tissue, reduces surgical trauma in esophageal cancer, has not increased postoperative recurrent metastases, while achieved the same long-term outcomes as expanded surgery.
比较保留奇静脉、胸导管及周围组织的改良Ivor-Lewis手术与切除这些组织的传统Ivor-Lewis手术治疗食管鳞状细胞癌的临床效果，评估食管癌手术是否需要切除奇静脉、胸导管及周围组织。
回顾性分析2017年9月至2019年9月甘肃省人民医院胸外科收治的行胸腹腔镜Ivor-Lewis手术治疗的食管癌患者的临床资料。根据手术方式，将其分为改良胸腹腔镜Ivor-Lewis组（改良组）和传统胸腹腔镜Ivor-Lewis组（传统组）。采用倾向评分匹配分析（PSM）以减少混杂因素的选择偏倚。
本研究共纳入245例行胸腹腔镜Ivor-Lewis手术的食管癌患者。改良组124例，传统组121例。传统组和改良组患者的年龄和T分期差异有统计学意义。PSM后，上述因素差异无统计学意义。PSM后每组各有86例患者。与传统组相比，改良组手术时间较短（=0.007）、术中出血量较少（=0.003）、术后3天胸腔引流量较少（=0.001），差异有统计学意义。两组术后局部复发（=0.721）和远处转移（=0.742）差异无统计学意义。改良组与传统组术后3年生存率（44.2%对41.9%，=0.605）差异也无统计学意义。
保留奇静脉、胸导管及周围组织的改良Ivor-Lewis手术可减少食管癌手术创伤，未增加术后复发转移，同时取得了与扩大手术相同的长期疗效。
