Igaue Shota, Fujita Takeo, Oguma Junya, Ishiyama Koshiro, Sato Kazuma, Kurita Daisuke, Kubo Kentaro, Utsunomiya Daichi, Nozaki Ryoko, Imazeki Hiroshi, Yamamoto Shun, Kato Ken, Daiko Hiroyuki
Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan; Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Esophageal Surgery, National Cancer Center Hospital East, Chiba, Japan.
Ann Thorac Surg. 2025 Apr;119(4):805-814. doi: 10.1016/j.athoracsur.2024.09.004. Epub 2024 Sep 12.
Thoracoscopic esophagectomy is a less invasive surgical procedure; however, evidence of its effect on long-term survival is limited. We evaluated long-term survival after the procedure in patients with esophageal carcinoma.
This retrospective multicenter study involved 1559 consecutive patients with esophageal carcinoma who underwent thoracoscopic esophagectomy or open esophagectomy between 2012 and 2019 at 2 Japanese high-volume cancer centers. Propensity score matching analysis was performed to compare short- and long-term outcomes. In addition, stage-specific survival rates were compared between the groups.
There were 313 patients who were matched and analyzed. The 1-, 3-, and 5-year overall survival rates were 84.5%, 60.5%, and 52.1%, respectively, in the matched open esophagectomy group; and 87.2%, 68.6%, and 61.8%, respectively, in the matched thoracoscopic esophagectomy group. The weighted Cox regression model showed significantly better survival in the thoracoscopic esophagectomy group than in the open esophagectomy group (hazard ratio, 0.74; 95% CI, 0.582-0.941). Deaths from other causes occurred more frequently in the open esophagectomy group than in the thoracoscopic esophagectomy group. Stratified analysis showed no significant survival differences between clinical stage I or II and pathologic stage 0 or I subgroups. However, the thoracoscopic esophagectomy groups with clinical stage III or IV and pathologic stage II, III, or IV had significantly better overall survival.
This study demonstrated the survival benefits of thoracoscopic esophagectomy, particularly for highly advanced esophageal carcinoma.
胸腔镜食管切除术是一种侵入性较小的外科手术；然而，其对长期生存影响的证据有限。我们评估了食管癌患者接受该手术后的长期生存情况。
这项回顾性多中心研究纳入了2012年至2019年期间在日本两家大型癌症中心连续接受胸腔镜食管切除术或开放性食管切除术的1559例食管癌患者。进行倾向评分匹配分析以比较短期和长期结局。此外，还比较了两组之间的分期特异性生存率。
共有313例患者进行了匹配和分析。在匹配的开放性食管切除术组中，1年、3年和5年总生存率分别为84.5%、60.5%和52.1%；在匹配的胸腔镜食管切除术组中，分别为87.2%、68.6%和61.8%。加权Cox回归模型显示，胸腔镜食管切除术组的生存率显著高于开放性食管切除术组（风险比，0.74；95%CI，0.582-0.941）。开放性食管切除术组因其他原因导致的死亡比胸腔镜食管切除术组更频繁。分层分析显示，临床I期或II期以及病理0期或I期亚组之间的生存无显著差异。然而，临床III期或IV期以及病理II期、III期或IV期的胸腔镜食管切除术组的总生存率显著更高。
本研究证明了胸腔镜食管切除术的生存获益，尤其是对于高度进展期食管癌。
