Long-term Survival in Esophageal Cancer: Comparison of Minimally Invasive and Open Esophagectomy.

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery Pub Date : 2024-09-12 DOI:10.1016/j.athoracsur.2024.09.004

Shota Igaue, Takeo Fujita, Junya Oguma, Koshiro Ishiyama, Kazuma Sato, Daisuke Kurita, Kentaro Kubo, Daichi Utsunomiya, Ryoko Nozaki, Hiroshi Imazeki, Shun Yamamoto, Ken Kato, Hiroyuki Daiko

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引用次数: 0

Abstract

Background: Thoracoscopic esophagectomy is a less invasive surgical procedure; however, evidence of its effect on long-term survival is limited. We evaluated long-term survival after the procedure in patients with esophageal carcinoma.

Methods: This retrospective multicenter study involved 1559 consecutive patients with esophageal carcinoma who underwent thoracoscopic esophagectomy or open esophagectomy between 2012 and 2019 at 2 Japanese high-volume cancer centers. Propensity score matching analysis was performed to compare short- and long-term outcomes. In addition, stage-specific survival rates were compared between the groups.

Results: There were 313 patients who were matched and analyzed. The 1-, 3-, and 5-year overall survival rates were 84.5%, 60.5%, and 52.1%, respectively, in the matched open esophagectomy group; and 87.2%, 68.6%, and 61.8%, respectively, in the matched thoracoscopic esophagectomy group. The weighted Cox regression model showed significantly better survival in the thoracoscopic esophagectomy group than in the open esophagectomy group (hazard ratio, 0.74; 95% CI, 0.582-0.941). Deaths from other causes occurred more frequently in the open esophagectomy group than in the thoracoscopic esophagectomy group. Stratified analysis showed no significant survival differences between clinical stage I or II and pathologic stage 0 or I subgroups. However, the thoracoscopic esophagectomy groups with clinical stage III or IV and pathologic stage II, III, or IV had significantly better overall survival.

Conclusions: This study demonstrated the survival benefits of thoracoscopic esophagectomy, particularly for highly advanced esophageal carcinoma.

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食管癌的长期生存率：微创食管切除术与开放式食管切除术的比较

背景：胸腔镜食管切除术是一种创伤较小的外科手术，但其对长期存活率影响的证据有限。我们评估了食管癌患者术后的长期生存率：这项回顾性多中心研究涉及 2012 年至 2019 年期间在日本两家大容量癌症中心接受胸腔镜食管切除术或开腹食管切除术的 1559 名连续食管癌患者。为比较短期和长期结果，进行了倾向得分匹配分析。此外，还比较了两组患者的分期生存率：对 313 名患者进行了匹配和分析。匹配的开放式食管切除术组的1年、3年和5年总生存率分别为84.5%、60.5%和52.1%；匹配的胸腔镜食管切除术组的1年、3年和5年总生存率分别为87.2%、68.6%和61.8%。加权考克斯回归模型显示，胸腔镜食管切除术组的生存率明显高于开放式食管切除术组（危险比=0.74，95% 置信区间：0.582-0.941）。与胸腔镜食管切除术组相比，开放式食管切除术组因其他原因死亡的发生率更高。分层分析表明，c期I或II亚组与p期0或I亚组的生存率无明显差异。然而，c期为III或IV期和p期为II、III或IV期的胸腔镜食管切除术组的总生存率明显更高：这项研究证明了胸腔镜食管切除术的生存优势，尤其是对高位晚期食管癌。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.