Jia Xiaocan, Ren Tongtong, Chen Peinan, Xin Xin, Zhang Yi, Yang Yongli
Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Science Avenue, High-tech Development Zone, Zhengzhou, 450001, Henan, China.
Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming Road, Jinshui District, Zhengzhou, 450008, Henan, China.
Surg Endosc. 2024 Dec;38(12):7341-7351. doi: 10.1007/s00464-024-11302-y. Epub 2024 Oct 21.
It is controversial whether there is a survival difference between open esophagectomy (OE) and thoracoscopic esophagectomy (TE) for esophageal cancer (EC). Therefore, this study aimed to compare the differences in survival and safety between two surgical approaches in patients with node-negative esophageal squamous cell carcinoma (ESCC).
This ambispective cohort study included 1104 patients with node-negative ESCC who received OE or TE treatment at a Grate-A tertiary hospital in Henan Province between January 2015 and December 2016. The primary endpoint was 5-year overall survival (OS) and disease-free survival (DFS), and the secondary endpoint was surgical safety. Multivariable Cox regression analysis was used to analyze the effect of surgical approaches on OS and DFS, and propensity score matching (PSM) was performed to match confounding factors between two groups.
Patients were followed up ranged from 1.03 to 91.60 months, with a median follow-up time of 67.37 months. Kaplan-Meier survival analysis showed statistically significant differences between OE and TE in OS (70.05% vs 83.73%, P < 0.001) and DFS (67.15% vs 77.76%, P < 0.001). Furthermore, multivariate Cox regression analysis also demonstrated significant differences in long-term survival between the two groups (OS, HR (95% CI): 0.54 (0.41, 0.70); DFS, HR (95% CI): 0.68 (0.54, 0.86)). TE was associated with a reduction in intraoperative bleeding (median: 100 ml vs. 200 ml, P < 0.001), and an increase in the number of lymph nodes dissection (median: 23 vs. 28, P < 0.001). Similar results were found after PSM.
In a selected cohort of patients with node-negative ESCC, TE surgical treatment was safer and had better long-term survival outcomes compared to OE. This provided corresponding clinical guidance to enhance survival benefits for patients. In the future, we hope to further explore the reasons for TE achieving higher survival rates.
对于食管癌（EC）患者，开放食管切除术（OE）和胸腔镜食管切除术（TE）在生存率上是否存在差异仍存在争议。因此，本研究旨在比较淋巴结阴性食管鳞状细胞癌（ESCC）患者两种手术方式在生存和安全性方面的差异。
本回顾性队列研究纳入了2015年1月至2016年12月期间在河南省一家三级甲等医院接受OE或TE治疗的1104例淋巴结阴性ESCC患者。主要终点为5年总生存期（OS）和无病生存期（DFS），次要终点为手术安全性。采用多变量Cox回归分析评估手术方式对OS和DFS的影响，并进行倾向评分匹配（PSM）以平衡两组间的混杂因素。
患者随访时间为1.03至91.60个月，中位随访时间为67.37个月。Kaplan-Meier生存分析显示，OE组和TE组在OS（70.05%对83.73%，P<0.001）和DFS（67.15%对77.76%，P<0.001）方面存在统计学显著差异。此外，多变量Cox回归分析也表明两组在长期生存方面存在显著差异（OS，HR（95%CI）：0.54（0.41，0.7）；DFS，HR（95%CI）：0.68（0.54，0.86））。TE与术中出血量减少（中位数：100ml对200ml，P<0.001）以及淋巴结清扫数量增加（中位数：23对28，P<0.001）相关。PSM后得到了类似结果。
在选定的淋巴结阴性ESCC患者队列中，与OE相比，TE手术治疗更安全，长期生存结果更好。这为提高患者生存获益提供了相应的临床指导。未来，我们希望进一步探究TE实现更高生存率的原因。
