Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan.
Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan.
Cancer Rep (Hoboken). 2023 Aug;6(8):e1850. doi: 10.1002/cnr2.1850. Epub 2023 Jun 20.
This study aimed to assess the superiority of 3D flexible thoracoscope against 2D thoracoscope for lymph node dissection (LND) and prognosis for prone-position thoracoscopic esophagectomy (TE) in esophageal cancer.
Three hundred and sixty-seven esophageal cancer patients who underwent prone-position TE with 3-field LND between 2009 and 2018 were evaluated. 2D and 3D thoracoscope was used in 182 (2D group) and 185 cases (3D group), respectively. Short-term surgical outcomes, numbers of retrieved mediastinal lymph node (LN), and rates of LN recurrence were compared. Risk factors for mediastinal LN recurrence and long-time prognosis were also evaluated.
No differences in postoperative complications were observed between the groups. The numbers of retrieved mediastinal LN were significantly higher, and the rates of LN recurrence were significantly lower in the 3D group compared to 2D group. Use of 2D thoracoscope was a significant independent factor of middle mediastinal LN recurrence by multivariable analysis. Survival was compared by cox regression analysis, and the 3D group had a significantly better prognosis than the 2D group.
Prone position TE using 3D thoracoscope may improve the accuracy of mediastinal LND and prognosis without increasing postoperative complications for esophageal cancer.
本研究旨在评估 3D 柔性胸腔镜在食管癌经俯卧位胸腔镜食管切除术（TE）中用于淋巴结清扫（LND）和预后方面相较于 2D 胸腔镜的优势。
对 2009 年至 2018 年间接受经俯卧位 3 野 LND 的 367 例食管癌患者进行评估。分别有 182 例（2D 组）和 185 例（3D 组）患者使用 2D 和 3D 胸腔镜。比较两组患者的短期手术结果、纵隔淋巴结（LN）的检出数目和 LN 复发率。还评估了纵隔 LN 复发的危险因素和长期预后。
两组患者术后并发症无差异。3D 组纵隔 LN 的检出数目明显更高，LN 复发率明显更低。多变量分析显示，使用 2D 胸腔镜是中纵隔 LN 复发的独立显著因素。通过 cox 回归分析比较生存情况，3D 组的预后明显优于 2D 组。
对于食管癌患者，使用 3D 胸腔镜的俯卧位 TE 可能提高纵隔 LND 的准确性和预后，而不会增加术后并发症。
