Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China.
Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China.
J Cancer Res Clin Oncol. 2023 Sep;149(11):8289-8296. doi: 10.1007/s00432-023-04765-4. Epub 2023 Apr 18.
Esophagectomy is regarded as one of the optimal treatments for resectable esophageal cancer. However, the impact of surgical approach on the long-term prognosis of esophageal cancer remains controversial. This study attempted to compare the long-term survival outcomes of patients receiving left and right thoracic esophagectomy for esophageal cancer.
A total of 985 patients underwent esophagectomy (including 453 left and 532 right thoracic approach) for esophageal cancer in Henan Cancer Hospital from January 2015 to December 2016 were enrolled. Their 5 year overall survival (OS) and disease-free survival (DFS) were retrospectively collected. Cox regression was performed to compare OS and DFS in patients who underwent left and right thoracic esophagectomy. Propensity score matching (PSM) analysis was used to balance confounding factors.
The 5 year OS rates were 60.21% in the left and 51.60% in the right thoracic esophagectomy, respectively (P = 0.67). The 5 year DFS rates were 56.73% in the left and 47.93% and in the right thoracic esophagectomy, respectively (P = 0.36). Cox regression analysis showed there was no significant difference in long-term survival between patients with left and right surgical access (OS: HR = 0.95, 95% CI 0.77-1.18; DFS: HR = 0.91, 95% CI 0.74-1.12). In the cohort of patients obtained by PSM, Cox regression analysis yielded the similar results.
For patients with resectable esophageal cancer, the surgical treatment through left thoracic approach can achieve the same long-term survival outcomes as the right thoracic approach.
食管癌切除术被认为是可切除食管癌的一种最佳治疗方法。然而，手术入路对食管癌长期预后的影响仍存在争议。本研究旨在比较左胸和右胸食管癌切除术患者的长期生存结果。
2015 年 1 月至 2016 年 12 月，河南肿瘤医院共收治 985 例食管癌患者（左胸 453 例，右胸 532 例），回顾性收集其 5 年总生存率（OS）和无病生存率（DFS）。采用 Cox 回归比较左、右胸食管癌切除术患者的 OS 和 DFS。采用倾向评分匹配（PSM）分析平衡混杂因素。
左胸和右胸食管癌切除术的 5 年 OS 率分别为 60.21%和 51.60%（P=0.67）。左胸和右胸食管癌切除术的 5 年 DFS 率分别为 56.73%和 47.93%（P=0.36）。Cox 回归分析显示，左、右手术入路患者的长期生存无显著差异（OS：HR=0.95，95%CI 0.77-1.18；DFS：HR=0.91，95%CI 0.74-1.12）。在 PSM 获得的患者队列中，Cox 回归分析得出了相似的结果。
对于可切除的食管癌患者，左胸入路手术治疗可获得与右胸入路相同的长期生存结果。
