Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, the Netherlands.
Cancer Center Amsterdam, Department of Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
Ann Surg. 2024 Aug 1;280(2):267-273. doi: 10.1097/SLA.0000000000006280. Epub 2024 Apr 5.
To determine the impact of operative approach [open (OE), hybrid minimally invasive (HMIE), and total minimally invasive (TMIE) esophagectomy] on operative and oncologic outcomes for patients treated with curative intent for esophageal and junctional cancer.
The optimum oncologic surgical approach to esophageal and junctional cancer is unclear.
This secondary analysis of the European multicenter ENSURE study includes patients undergoing curative-intent esophagectomy for cancer between 2009 and 2015 across 20 high-volume centers. Primary endpoints were disease-free survival (DFS) and the incidence and location of disease recurrence. Secondary endpoints included among others R0 resection rate, lymph node yield, and overall survival (OS).
In total, 3199 patients were included. Of these, 55% underwent OE, 17% HMIE, and 29% TMIE. DFS was independently increased post-TMIE [hazard ratio (HR): 0.86 (95% CI: 0.76-0.98), P = 0.022] compared with OE. Multivariable regression demonstrated no difference in absolute locoregional recurrence risk according to the operative approach [HMIE vs OE, odds ratio (OR): 0.79, P = 0.257; TMIE vs OE, OR: 0.84, P = 0.243]. The probability of systemic recurrence was independently increased post-HMIE (OR: 2.07, P = 0.031), but not TMIE (OR: 0.86, P = 0.508). R0 resection rates ( P = 0.005) and nodal yield ( P < 0.001) were independently increased after TMIE, but not HMIE ( P = 0.424; P = 0.512) compared with OE. OS was independently improved following both HMIE (HR: 0.79, P = 0.009) and TMIE (HR: 0.82, P = 0.003) as compared with OE.
In this European multicenter study, TMIE was associated with improved surgical quality and DFS, whereas both TMIE and HMIE were associated with improved OS as compared with OE for esophageal cancer.
确定手术方式（开放手术[OE]、杂交微创[HMIE]和全微创[TMIE]食管癌切除术）对接受根治性治疗的食管和交界性癌症患者的手术和肿瘤学结果的影响。
对于食管和交界性癌症，最佳的肿瘤外科手术方法尚不清楚。
本研究为欧洲多中心 ENSURE 研究的二次分析，纳入了 2009 年至 2015 年间在 20 家大容量中心接受根治性食管癌切除术的癌症患者。主要终点是无病生存率（DFS）和疾病复发的发生率和部位。次要终点包括 R0 切除率、淋巴结产量和总生存率（OS）等。
共纳入 3199 例患者。其中，55%接受 OE，17%接受 HMIE，29%接受 TMIE。与 OE 相比，TMIE 后 DFS 独立增加[风险比（HR）：0.86（95%可信区间：0.76-0.98），P = 0.022]。多变量回归显示，根据手术方式，局部区域复发的绝对风险无差异[HMIE 与 OE，比值比（OR）：0.79，P = 0.257；TMIE 与 OE，OR：0.84，P = 0.243]。HMIE 后（OR：2.07，P = 0.031），但 TMIE 后（OR：0.86，P = 0.508），系统复发的可能性独立增加。TMIE 后 R0 切除率（P = 0.005）和淋巴结产量（P < 0.001）独立增加，但 HMIE 后则不然（P = 0.424；P = 0.512）与 OE 相比。与 OE 相比，HMIE（HR：0.79，P = 0.009）和 TMIE（HR：0.82，P = 0.003）后 OS 独立改善。
在这项欧洲多中心研究中，与 OE 相比，TMIE 与改善的手术质量和 DFS 相关，而 TMIE 和 HMIE 均与改善的 OS 相关。
