Wang Kexi, Xie Xuan, He Jianqun, Fang Shuogui, Zhong Yiming, Wu Duoguang, Wang Kefeng, Wang Minghui
Department of Thoracic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Ann Med. 2025 Dec;57(1):2456691. doi: 10.1080/07853890.2025.2456691. Epub 2025 Jan 25.
The purpose of this study was to investigate the safety and efficacy of left thoracic approach (LTA) and right thoracic approach (RTA) in patients with esophageal squamous cell carcinoma (ESCC) after neoadjuvant immunochemotherapy (NICT).
This study included 83 ESCC patients who underwent right transthoracic esophagectomy ( = 61) and left transthoracic esophagectomy ( = 22) after NICT in our hospital from October 2019 to September 2023. The data of these patients were retrospectively analyzed.
Compared with the LTA group, the RTA group had a longer operation time (245.6 ± 27.8 min vs. 356.5 ± 83.2 min, < 0.001) and more lymph nodes were removed (21.0 ± 7.9 vs. 29.3 ± 10.8, = 0.001). The 3-year disease free survival (DFS) of the LTA group and the RTA group were 61.0% and 65.7% ( = 0.861), and the 3-year overall survival (OS) were 60.7% and 77.4% ( = 0.753) respectively. There was no significant difference in prognosis between the two groups. Lymphovascular invasion was an independent risk factor for DFS (HR = 4.042, = 0.004) and OS (HR = 4.607, = 0.003) in patients with ESCC undergoing NICT combined with surgery.
There was no difference in postoperative complications and short-term survival in patients with ESCC underwent surgery after NICT regardless of left or right thoracic approach. It is worth noting that lymphovascular invasion has an important impact on the prognosis of these patients.
本研究旨在探讨新辅助免疫化疗（NICT）后，左胸入路（LTA）和右胸入路（RTA）治疗食管鳞状细胞癌（ESCC）患者的安全性和有效性。
本研究纳入了2019年10月至2023年9月期间在我院接受NICT后行右胸段食管癌切除术（n = 61）和左胸段食管癌切除术（n = 22）的83例ESCC患者。对这些患者的数据进行回顾性分析。
与LTA组相比，RTA组手术时间更长（245.6 ± 27.8分钟 vs. 356.5 ± 83.2分钟，P < 0.001），切除的淋巴结更多（21.0 ± 7.9枚 vs. 29.3 ± 10.8枚，P = 0.001）。LTA组和RTA组的3年无病生存率（DFS）分别为61.0%和65.7%（P = 0.861），3年总生存率（OS）分别为60.7%和77.4%（P = 0.753）。两组预后无显著差异。在接受NICT联合手术的ESCC患者中，脉管侵犯是DFS（HR = 4.042，P = 0.004）和OS（HR = 4.607，P = 0.003）的独立危险因素。
NICT后接受手术的ESCC患者，无论采用左胸入路还是右胸入路，术后并发症和短期生存均无差异。值得注意的是，脉管侵犯对这些患者的预后有重要影响。
