Esophageal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
Esophageal Surgery Division, National Cancer Center Hospital East, Chiba, Japan.
Surg Endosc. 2024 Oct;38(10):5746-5755. doi: 10.1007/s00464-024-11167-1. Epub 2024 Aug 13.
Transcervical mediastinoscopic esophagectomy for esophageal and esophagogastric junction cancer is indicated in select institutions because of the complex surgical technique required and the unfamiliar surgical view compared with the standard transthoracic esophagectomy approach. This study was performed to compare the feasibility and efficacy of bilateral transcervical mediastinoscopic-assisted transhiatal laparoscopic esophagectomy (BTC-MATLE) with thoracolaparoscopic esophagectomy (TLE) for esophageal cancer.
This study involved 392 consecutive patients with esophageal cancer who underwent curative minimally invasive esophagectomy with R0 resection (excluding salvage, conversion, and two-stage operations and open thoracotomy) at the National Cancer Center Hospital from 2017 to 2022. The patients underwent either BTC-MATLE or TE (32 and 360 consecutive patients, respectively). Propensity score-matching analysis was used to balance the baseline differences by covariates of age, performance status, and clinical stage.
There were statistically significant differences in age, performance status, cT factor, cN factor, cStage, preoperative treatment, and surgical history for respiratory disease. After propensity score-matching, these significant differences (excluding a surgical history of respiratory disease) were no longer statistically significant, and 27 patients were assigned to each group. The total operation time and the postoperative intensive care unit stay were significantly shorter in the BTC-MATLE than TLE group. There were no significant differences in overall postoperative complications or the three major postoperative complications of recurrent laryngeal nerve paralysis, anastomotic leakage, and pneumonia, even for patients whose preoperative pulmonary function indices (vital capacity and forced expiratory volume in 1 s) were significantly lower in the BTC-MATLE than TLE group. The numbers of total and thoracic harvested lymph nodes were significantly higher in the TLE than BTC-MATLE group; however, there was no significant difference in the recurrence rate between the two groups.
BTC-MATLE may provide the same feasibility and oncological outcomes as TLE even for patients with significantly lower pulmonary function.
经颈纵隔镜食管切除术用于食管和食管胃交界癌，在某些机构中是可行的，因为与标准的经胸食管切除术方法相比，该手术需要复杂的手术技术和不熟悉的手术视野。本研究旨在比较双侧经颈纵隔镜辅助经食管裂孔腹腔镜食管切除术（BTC-MATLE）与胸腹腔镜食管切除术（TLE）治疗食管癌的可行性和疗效。
本研究纳入了 2017 年至 2022 年期间在国家癌症中心医院接受根治性微创食管切除术（R0 切除，不包括挽救性、转化性和两阶段手术以及开胸手术）且可评估的 392 例食管癌患者。患者接受 BTC-MATLE 或 TE（分别为 32 例和 360 例连续患者）。采用倾向评分匹配分析，根据年龄、体力状况和临床分期等协变量平衡基线差异。
两组患者在年龄、体力状况、cT 因子、cN 因子、c 期、术前治疗和呼吸系统疾病手术史方面存在统计学差异。经倾向评分匹配后，这些显著差异（不包括呼吸系统疾病手术史）不再具有统计学意义，每组 27 例患者。BTC-MATLE 组的总手术时间和术后重症监护病房停留时间明显短于 TLE 组。两组患者的总术后并发症发生率或三大主要术后并发症（喉返神经麻痹、吻合口漏和肺炎）发生率均无显著差异，即使 BTC-MATLE 组患者的术前肺功能指标（肺活量和 1 秒用力呼气量）明显低于 TLE 组。TLE 组的总淋巴结和胸内淋巴结采集数量明显多于 BTC-MATLE 组；然而，两组的复发率无显著差异。
即使对于肺功能明显较低的患者，BTC-MATLE 也可提供与 TLE 相同的可行性和肿瘤学结果。
