微创与开放式食管切除术治疗可切除的胸段食管癌(NST 1502):一项多中心前瞻性队列研究

Yousheng Mao , Shugeng Gao , Yin Li , Chun Chen , Anlin Hao , Qun Wang , Lijie Tan , Jianqun Ma , Gaoming Xiao , Xiangning Fu , Wentao Fang , Zhigang Li , Yongtao Han , Keneng Chen , Renquan Zhang , Xiaofei Li , Tiehua Rong , Jianhua Fu , Yongyu Liu , Weimin Mao , Jie He
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引用次数: 1

摘要

背景微创食管切除术(MIE)治疗食管鳞状细胞癌(ESCC)是否优于开放式食管切除术仍不确定。因此,这项多中心前瞻性研究旨在比较MIE和OE在术后参数和长期生存率方面的差异。方法2015年4月1日至2018年12月31日,所有接受MIE或OE治疗的cT1b-3N0–1M0胸部ESCC住院患者均来自19个选定的中心。进行倾向评分匹配(PSM)以最小化选择偏差。通过R版本3.6.2比较两组的基本临床病理特征、3年总生存期(OS)和无病生存期(DFS)。结果1387例患者进行了IE,335例患者进行OE。每组335例病例最终通过PSM匹配,PSM后MIE组和OE组在基本人口统计学特征上没有观察到显著差异。与OE相比,MIE术中出血显著减少,总引流量减少,术后住院时间缩短,淋巴结数量显著增加(均P<0.001)。MIE与OE在术后主要并发症和死亡率方面无显著差异。MIE组的3年OS和DFS分别为77.0%和68.1%,而OE组分别为69.3%和60.9%(OS:P=0.03;DFS:P=0.09),对于cII期患者,MIE组和OE组的发生率分别为75.1%和66.5%,而OS:P=0.04,DFS:P0.09)分别为66.9%和58.6%。结论与OE相比,MIE是一种安全有效的治疗方法,死亡率和发病率相似。它在收集更多的LNs、提高CI-ESC期患者的术后恢复和生存方面具有优势。
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Minimally invasive versus open esophagectomy for resectable thoracic esophageal cancer (NST 1502): a multicenter prospective cohort study

Background

Whether minimally invasive esophagectomy (MIE) is superior to open esophagectomy (OE) in the treatment of esophageal squamous cell carcinoma (ESCC) is still uncertain. Therefore, this multicenter prospective study aimed to compare MIE with OE in postoperative parameters and long-term survival.

Methods

All hospitalized patients with cT1b-3N0–1M0 thoracic ESCC treated by MIE or OE were enrolled from 19 selected centers from April 1, 2015 to December 31, 2018. The propensity score matching (PSM) was performed to minimize the selection bias. The basic clinicopathological characteristics and 3-year overall survival (OS) as well as disease-free survival (DFS) of two groups were compared by R version 3.6.2.

Results

MIE were performed in 1,387 patients and OE in 335 patients. 335 cases in each group were finally matched by PSM, and no significant differences in the essential demographic characteristics were observed between the MIE and OE groups after PSM. Compared with OE, MIE had significantly less intraoperative bleeding, less total drainage volume, shorter postoperative hospital stay, and harvested significantly more lymph nodes (LNs) (all P < 0.001). There were no significant differences in the major postoperative complications and death rates between MIE and OE. The 3-year OS and DFS were 77.0% and 68.1% in the MIE group versus 69.3% and 60.9% in the OE group (OS: P = 0.03; DFS: P = 0.09), and the rates were 75.1% and 66.5% in the MIE group versus 66.9% and 58.6% in the OE group for stage cII patients (OS: P = 0.04, DFS: P = 0.09), respectively.

Conclusions

Compared with OE, MIE is a safe and effective treatment approach with similar mortality and morbidity. It has the advantages in harvesting more LNs, improving postoperative recovery and survival of stage cII ESCC patients.

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