Survival Comparison Between Open and Thoracoscopic Esophagectomy for Esophageal Squamous Cell Carcinoma Stratified by Pathological Tumor-Node-Metastasis Stage: An Overlap Weighting Analysis.

BACKGROUND

The survival differences between open esophagectomy (OE) and thoracoscopic esophagectomy (TE) for patients with esophageal squamous cell carcinoma (ESCC) across different pathological tumor-node-metastasis stage (pStage) remain controversial. Therefore, this study aims to compare long-term survival between OE and TE in patients with ESCC across different pStage groups using overlap weighting.

PATIENTS AND METHODS

This ambispective cohort study analyzed patients with ESCC who underwent OE or TE between January 2015 and December 2016 at a tertiary hospital in Henan Province. The primary endpoints were 5-year overall survival (OS), while disease-free survival (DFS) was a secondary endpoint. Operation safety was also assessed. Cox regression was used after overlap weighting, with sensitivity analysis by propensity score matching.

RESULTS

The study cohort included 1715 eligible patients. Median survival was 66.07 months for pStage 0/I/II and 38.47 months for pStage III/IV. Overlap-weighted Cox regression showed significant survival benefits of TE. In the pStage 0/I/II group, the hazard ration (HR) for OS was 0.43 (95% confidence intervals, CI: 0.33-0.57) and for DFS was 0.44 (95% CI: 0.33-0.58). In the pStage III/IV group, the HR for OS was 0.70 (95% CI: 0.57-0.87) and for DFS was 0.73 (95% CI: 0.58-0.90). TE reduced blood loss, increased lymph node dissection, and lowered anastomotic leaks, though it required longer operative time and higher costs (P < 0.05).

CONCLUSIONS

TE improved OS and DFS and operation safety compared with OE in patients with early and advanced-stage ESCC after adjusting for confounding factors.