The Prognostic Impact of Minimally Invasive Esophagectomy on Survival After Esophagectomy Following a Delayed Interval After Chemoradiotherapy: A Secondary Analysis of the DICE Study.
Sheraz R Markar, Bruno Sgromo, Richard Evans, Ewen A Griffiths, Rita Alfieri, Carlo Castoro, Caroline Gronnier, Christian A Gutschow, Guillaume Piessen, Giovanni Capovilla, Peter P Grimminger, Donald E Low, James Gossage, Suzanne S Gisbertz, Jelle Ruurda, Richard van Hillegersberg, Xavier Benoit D'journo, Alexander W Phillips, Ricardo Rosati, George B Hanna, Nick Maynard, Wayne Hofstetter, Lorenzo Ferri, Mark I Berge Henegouwen, Richard Owen
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引用次数: 0
Abstract
Objective: To evaluate prognostic differences between minimally invasive esophagectomy (MIE) and open esophagectomy (OE) in patients with surgery after a prolonged interval (>12 wk) following chemoradiotherapy (CRT).
Background: Previously, we established that a prolonged interval after CRT before esophagectomy was associated with poorer long-term survival.
Methods: This was an international multicenter cohort study involving 17 tertiary centers, including patients who received CRT followed by surgery between 2010 and 2020. Patients undergoing MIE were defined as thoracoscopic and laparoscopic approaches.
Results: A total of 428 patients (145 MIE and 283 OE) had surgery between 12 weeks and 2 years after CRT. Significant differences were observed in American Society of Anesthesiologists grade, radiation dose, clinical T stage, and histologic subtype. There were no significant differences between the groups in age, sex, body mass index, pathologic T or N stage, resection margin status, tumor location, surgical technique, or 90-day mortality. Survival analysis showed MIE was associated with improved survival in univariate ( P =0.014), multivariate analysis after adjustment for smoking, T and N stage, and histology (HR=1.69; 95% CI: 1.14-2.5) and propensity-matched analysis ( P =0.02). Further subgroup analyses by radiation dose and interval after CRT showed survival advantage for MIE in 40 to 50 Gy dose groups (HR=1.9; 95% CI: 1.2-3.0) and in patients having surgery within 6 months of CRT (HR=1.6; 95% CI: 1.1-2.2).
Conclusions: MIE was associated with improved overall survival compared with OE in patients with a prolonged interval from CRT to surgery. The mechanism for this observed improvement in survival remains unknown, with potential hypotheses including a reduction in complications and improved functional recovery after MIE.
微创食管切除术对化疗放疗延迟后食管切除术后生存期的预后影响；DICE 研究的二次分析》（The Prognostic Impact of Minimally Invasive Esophagectomy on Survival after a Delayed Interval after Chemoradiotherapy; A Secondary Analysis of DICE Study）。
目的评估化放疗（CRT）后间隔时间较长（>12周）后接受手术的患者在微创食管切除术（MIE）和开放式食管切除术（OE）之间的预后差异：背景：我们曾证实，食管切除术前化疗间隔时间过长与长期生存率较低有关：这是一项国际多中心队列研究，涉及 17 个三级中心，包括在 2010-2020 年间接受 CRT 后进行手术的患者。接受MIE的患者被定义为胸腔镜和腹腔镜方法：428名患者（145名MIE患者和283名OE患者）在CRT术后12周至两年期间接受了手术。在ASA分级、放射剂量、临床T分期和组织学亚型方面观察到显著差异。组间在年龄、性别、体重指数、病理T或N分期、切除边缘状态、肿瘤位置、手术技术或90天死亡率方面无明显差异。生存分析表明，在单变量分析（P=0.014）、调整吸烟、T和N分期及组织学后的多变量分析（HR=1.69；95% CI 1.14至2.5）和倾向匹配分析（P=0.02）中，MIE与生存率的提高相关。按放射剂量和CRT后间隔时间进行的进一步亚组分析显示，MIE在40-50Gy剂量组（HR=1.9；95% CI 1.2-3.0）和CRT后6个月内接受手术的患者（HR=1.6；95% CI 1.1-2.2）中具有生存优势：结论：在从CRT到手术间隔时间较长的患者中，与OE相比，MIE与总生存率的改善相关。所观察到的生存率提高的机制尚不清楚，可能的假设包括并发症的减少和MIE后功能恢复的改善。
期刊介绍：
The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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