Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands,
Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Dig Surg. 2023;40(1-2):58-68. doi: 10.1159/000530019. Epub 2023 Mar 7.
The balance between potential oncological merits and surgical risks is unclear for the additional step of performing paratracheal lymphadenectomy during esophagectomy for cancer. This study aimed to investigate the impact of paratracheal lymphadenectomy on lymph node yield and short-term outcomes in patients who underwent this procedure in the Netherlands.
Patients who underwent neoadjuvant chemoradiotherapy followed by transthoracic esophagectomy were included from the Dutch Upper Gastrointestinal Cancer Audit (DUCA). After propensity score matching Ivor Lewis and McKeown approaches separately, lymph node yield and short-term outcomes were compared between patients who underwent paratracheal lymphadenectomy versus patients who did not.
Between 2011 and 2017, 2,128 patients were included. Some 770 patients (n = 385 vs. n = 385) and 516 patients (n = 258 vs. n = 258) were matched for the Ivor Lewis and McKeown approaches, respectively. Paratracheal lymphadenectomy was associated with a higher lymph node yield in Ivor Lewis (23 vs. 19 nodes, p < 0.001) and McKeown (21 vs. 19 nodes, p = 0.015) esophagectomy. There were no significant differences in complications or mortality. After Ivor Lewis esophagectomy, paratracheal lymphadenectomy was associated with longer length of stay (12 vs. 11 days, p < 0.048). After McKeown esophagectomy, paratracheal lymphadenectomy was associated with more re-interventions (30% vs. 18%, p = 0.002).
Paratracheal lymphadenectomy resulted in a higher lymph node yield but also in longer length of stay after Ivor Lewis and more re-interventions following McKeown esophagectomy.
在癌症患者接受食管癌切除术时，行气管旁淋巴结清扫术是否具有潜在的肿瘤学优势和手术风险尚不清楚。本研究旨在探讨荷兰行气管旁淋巴结清扫术对患者淋巴结获取量和短期结局的影响。
从荷兰上消化道癌症审计（DUCA）中纳入接受新辅助放化疗后行经胸食管癌切除术的患者。分别通过倾向评分匹配 Ivor Lewis 和 McKeown 方法后，比较行气管旁淋巴结清扫术和未行气管旁淋巴结清扫术的患者的淋巴结获取量和短期结局。
2011 年至 2017 年间，共纳入 2128 例患者。分别有 770 例患者（n = 385 例 vs. n = 385 例）和 516 例患者（n = 258 例 vs. n = 258 例）进行了 Ivor Lewis 和 McKeown 方法的匹配。在 Ivor Lewis（23 个 vs. 19 个淋巴结，p < 0.001）和 McKeown（21 个 vs. 19 个淋巴结，p = 0.015）食管癌切除术，行气管旁淋巴结清扫术与更高的淋巴结获取量相关。两组在并发症或死亡率方面无显著差异。行 Ivor Lewis 食管癌切除术时，行气管旁淋巴结清扫术与住院时间延长相关（12 天 vs. 11 天，p < 0.048）。行 McKeown 食管癌切除术时，行气管旁淋巴结清扫术与更多再干预相关（30% vs. 18%，p = 0.002）。
行气管旁淋巴结清扫术可增加淋巴结获取量，但 Ivor Lewis 食管癌切除术后住院时间延长，McKeown 食管癌切除术后再干预更多。
