Department of Thoracic Surgery, The Sixth Medical Center of Chinese, PLA General Hospital, Beijing, China.
The Second Clinical College of Southern Medical University, Guangzhou, China.
Ann Surg Oncol. 2023 Oct;30(11):6730-6736. doi: 10.1245/s10434-023-13748-1. Epub 2023 Jun 26.
Minimally invasive esophagectomy (MIE) has been used widely for the treatment of esophageal cancer. However, the optimal extent of lymphadenectomy for esophagectomy in MIE remains unclear. This trial aimed to investigate the 3-year survival and recurrence outcomes in a randomized controlled trial comparing MIE with either three-field lymphadenectomy (3-FL) or two-field lymphadenectomy (2-FL).
Between June 2016 and May 2019, 76 patients with resectable thoracic esophageal cancer were enrolled in a single-center randomized controlled trial and randomly assigned to MIE that included either 3-FL or 2-FL at a 1:1 ratio (n = 38 patients each). The survival outcomes and recurrence patterns were compared between the two groups.
The 3-year cumulative overall survival (OS) probability was 68.2 % (95 % confidence interval [CI], 52.72-83.68 %) for the 3-FL group and 68.6 % (95 % CI, 53.12-84.08 %) for the 2-FL group. The 3-year cumulative probability of disease-free survival (DFS) was 66.3 % (95 % CI, 50.03-82.57 %) for the 3-FL group and 67.1 % (95 % CI, 51.03-83.17 %) for the 2-FL group.. The OS and DFS differences in the two groups were comparable. The overall recurrence rate did not differ significantly between the two groups (P = 0.737). The incidence of cervical lymphatic recurrence in the 2-FL group was higher than in the 3-FL group (P = 0.051).
Compared with 2-FL in MIE, 3-FL tended to prevent cervical lymphatic recurrence. However, it was not found to add survival benefit for the patients with thoracic esophageal cancer.
微创食管切除术（MIE）已广泛用于治疗食管癌。然而，MIE 中食管切除术的最佳淋巴结清扫范围仍不清楚。本试验旨在研究一项随机对照试验中，MIE 与三野淋巴结清扫（3-FL）或二野淋巴结清扫（2-FL）相比的 3 年生存率和复发结果。
2016 年 6 月至 2019 年 5 月，76 例可切除胸段食管癌患者入组单中心随机对照试验，并按 1:1 比例随机分为 MIE 组，包括 3-FL 或 2-FL（每组 38 例）。比较两组患者的生存结局和复发模式。
3-FL 组 3 年累积总生存率（OS）概率为 68.2%（95%置信区间[CI]，52.72%-83.68%），2-FL 组为 68.6%（95%CI，53.12%-84.08%）。3-FL 组 3 年无病生存率（DFS）累积概率为 66.3%（95%CI，50.03%-82.57%），2-FL 组为 67.1%（95%CI，51.03%-83.17%）。两组间 OS 和 DFS 差异无统计学意义。两组总体复发率无显著差异（P = 0.737）。2-FL 组颈淋巴结复发率高于 3-FL 组（P = 0.051）。
与 MIE 中的 2-FL 相比，3-FL 倾向于预防颈淋巴结复发。然而，它并未发现对胸段食管癌患者有生存获益。
