Ni Zhichao, Zhu Zigui, Shi Xin, Xia Xi, Liu Yan, Cui YeHua, Zhang Yi, Zhang Jianxin
Department of General Thoracic and Cardiovascular Surgery, The Affiliated Nanhua Hospital, Hengyang Medical College, University of South China, Hengyang, Hunan, China.
Intensive Care Unit, The Affiliated Nanhua Hospital, Hengyang Medical College, University of South China, Hengyang, Hunan, China.
Front Oncol. 2025 Aug 18;15:1644505. doi: 10.3389/fonc.2025.1644505. eCollection 2025.
Esophageal squamous cell carcinoma remains a major health burden in China, where surgical resection is the mainstay of curative therapy. The conventional minimally invasive McKeown esophagectomy (MIE-McKeown), although oncologically effective, entails transthoracic access and single-lung ventilation, often resulting in higher postoperative morbidity. Thoraco-laparoscopic transmediastinal esophagectomy has emerged as a novel alternative that may mitigate these risks while preserving oncologic integrity.
A retrospective cohort study was conducted involving 268 patients with resectable middle or lower thoracic esophageal squamous cell carcinoma (clinical stage I-III), including 131 who underwent transmediastinal esophagectomy and 137 who received MIE-McKeown. Outcomes assessed included operative time, intraoperative blood loss, lymph node yield, complication profiles, recovery indicators, quality of life (EORTC QLQ-C30), and 6-month disease-free survival (DFS). Statistical comparisons were performed using t-tests, χ² tests, and multivariate logistic regression.
The transmediastinal esophagectomy group exhibited significantly shorter operative time (197.2 ± 25.9 286.5 ± 32.1 min, <0.001) and reduced blood loss (155.4 ± 40.2 260.7 ± 65.1 mL, <0.001). Time to oral intake (4.6 ± 1.1 6.2 ± 1.3 days, <0.001), drainage duration (3.8 ± 0.5 4.4 ± 0.7 days, <0.001), and hospital stay (9.3 ± 1.8 11.1 ± 2.2 days, <0.001) were all significantly improved in the transmediastinal esophagectomy group. The incidence of Clavien-Dindo grade ≥III complications was lower (7.6% 16.0%, =0.043), particularly pneumonia (7.6% 18.2%, =0.009) and recurrent laryngeal nerve injury (4.6% 11.7%, =0.031). Lymph node harvest was comparable (21.4 ± 6.2 22.1 ± 5.9, =0.344). Three-month quality-of-life scores were higher in the transmediastinal esophagectomy group for global health (73.4 ± 12.1 66.5 ± 13.4, =0.005), physical functioning (78.2 ± 11.8 70.6 ± 13.6, =0.008), and role functioning (72.1 ± 14.2 64.3 ± 15.1, =0.011). The 6-month DFS rates were similar between groups (93.1% 91.2%, log-rank =0.327).
Thoraco-laparoscopic transmediastinal esophagectomy is a safe, effective, and minimally invasive alternative to the McKeown approach in selected esophageal squamous cell carcinoma patients. It provides superior perioperative outcomes and enhanced recovery without compromising short-term oncologic efficacy.
食管鳞状细胞癌仍是中国的一项重大健康负担，手术切除是根治性治疗的主要手段。传统的微创麦克尤恩食管切除术（MIE-McKeown）虽然在肿瘤学上有效，但需要经胸入路和单肺通气，常导致较高的术后发病率。胸腹腔镜经纵隔食管切除术已成为一种新的替代方法，可能会降低这些风险，同时保持肿瘤学的完整性。
进行了一项回顾性队列研究，纳入268例可切除的胸段中下段食管鳞状细胞癌患者（临床分期I-III期），其中131例行经纵隔食管切除术，137例行MIE-McKeown手术。评估的结果包括手术时间、术中出血量、淋巴结收获量、并发症情况、恢复指标、生活质量（欧洲癌症研究与治疗组织QLQ-C30量表）和6个月无病生存率（DFS）。采用t检验、χ²检验和多因素逻辑回归进行统计学比较。
经纵隔食管切除术组的手术时间明显更短（197.2±25.9对286.5±32.1分钟，<0.001），出血量减少（155.4±40.2对260.7±65.1毫升，<0.001）。经纵隔食管切除术组的经口进食时间（4.6±1.1对6.2±1.3天，<0.001）、引流持续时间（3.8±0.5对4.4±0.7天，<0.001）和住院时间（9.3±1.8对11.
