Otsuka Koji, Goto Satoru, Ariyoshi Tomotake, Yamashita Takeshi, Saito Akira, Kohmoto Masahiro, Kato Rei, Motegi Kentaro, Yajima Nobuyuki, Murakami Masahiko
Esophageal Cancer Center, Showa University Hospital, Tokyo, JPN.
Department of Medicine, Division of Rheumatology, Showa University School of Medicine, Tokyo, JPN.
Cureus. 2024 Jul 21;16(7):e65053. doi: 10.7759/cureus.65053. eCollection 2024 Jul.
Thoracoscopic esophagectomy (TE) with carbon dioxide (CO)insufflation is increasingly performed for esophageal cancer; however, there is limited evidence of the long-term outcomes of CO insufflation on postoperative survival.
We investigated the long-term outcomes of TE with or without CO insufflation.
We enrolled 182 patients who underwent TE for esophageal cancer between January 2003 and October 2013 and categorized them into two groups: with and without CO insufflation. The primary endpoint was five-year overall survival (5y-OS). Secondary endpoints included long-term outcomes, such as five-year relapse-free survival (5y-RFS) and five-year cancer-specific survival (5y-CSS), and short-term outcomes, such as surgical and non-surgical complications and reoperation within 30 days.
Follow-up until death or the five-year postoperative period was 98.9% (median follow-up duration was six years in survivors). After adjusting for age, sex, and yield pathologic tumor, node, and metastasis (TNM) stage, we found no significant differences in 5y-OS (HR 1.12, 95% CI 0.66-1.91), 5y-RFS (HR 1.12, 95% CI 0.67-1.83), or 5y-CSS rates (HR 1.00, 95% CI 0.57-1.75). For short-term outcomes, significant intergroup differences in operation time (p=0.02), blood loss (p<0.001), postoperative length of stay (p<0.001), and incidence of atelectasis (p=0.004) were observed. The results of the sensitivity analysis were similar to the main results.
In thoracoscopic procedures, CO insufflation significantly improved short-term outcomes, and it appears that the recurrence risk of esophageal cancer may not impact the long-term prognosis. While the influence of CO insufflation in thoracoscopic esophageal surgery remains unclear, our study suggests that the long-term prognosis is not compromised in other thoracic surgeries.
二氧化碳（CO₂）气腹的胸腔镜食管切除术（TE）在食管癌治疗中应用日益广泛；然而，关于CO₂气腹对术后生存的长期影响的证据有限。
我们研究了有无CO₂气腹的TE的长期疗效。
我们纳入了2003年1月至2013年10月期间接受TE治疗食管癌的182例患者，并将他们分为两组：有CO₂气腹组和无CO₂气腹组。主要终点是五年总生存率（5y-OS）。次要终点包括长期疗效，如五年无复发生存率（5y-RFS）和五年癌症特异性生存率（5y-CSS），以及短期疗效，如手术和非手术并发症以及30天内再次手术。
随访至死亡或术后五年，随访率为98.9%（幸存者的中位随访时间为六年）。在调整年龄、性别和病理肿瘤、淋巴结和转移（TNM）分期后，我们发现5y-OS（风险比[HR]1.12，95%置信区间[CI]0.66-1.91）、5y-RFS（HR 1.12，95%CI 0.67-1.83）或5y-CSS率（HR 1.00，95%CI 0.57-1.75）无显著差异。对于短期疗效，观察到两组在手术时间（p=0.02）、失血量（p<0.001）、术后住院时间（p<0.001）和肺不张发生率（p=0.004）方面存在显著差异。敏感性分析结果与主要结果相似。
在胸腔镜手术中，CO₂气腹显著改善了短期疗效，并似乎食管癌的复发风险可能不会影响长期预后。虽然CO₂气腹在胸腔镜食管手术中的影响仍不清楚，但我们的研究表明，在其他胸科手术中，长期预后不受影响。
