Minimally invasive versus open esophagectomy for resectable thoracic esophageal cancer (NST 1502): a multicenter prospective cohort study.

IF 7.6 Q1 ONCOLOGY

Journal of the National Cancer Center Pub Date : 2023-02-10 eCollection Date: 2023-06-01 DOI:10.1016/j.jncc.2023.02.002

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, Meiqing Xu, Shuoyan Liu, Zhentao Yu, Zhirong Zhang, Yan Fang, Donghong Fu, Xudong Wei, Ligong Yuan, Shan Muhammad, Jie He

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引用次数: 0

Abstract

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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针对可切除胸腔食管癌的微创与开腹食管切除术（NST 1502）：一项多中心前瞻性队列研究。

背景：在食管鳞状细胞癌（ESCC）的治疗中，微创食管切除术（MIE）是否优于开放食管切除术（OE）仍不确定。因此，这项多中心前瞻性研究旨在比较MIE与OE在术后指标和长期生存率方面的差异：2015年4月1日至2018年12月31日期间，19个选定中心入选了所有接受MIE或OE治疗的cT1b-3N0-1M0胸部ESCC住院患者。为尽量减少选择偏倚，进行了倾向得分匹配（PSM）。两组患者的基本临床病理特征、3年总生存期（OS）和无病生存期（DFS）用R 3.6.2版进行比较：对1 387名患者进行了MIE，对335名患者进行了OE。两组各有 335 例经 PSM 最终匹配，经 PSM 后，MIE 组和 OE 组在基本人口学特征方面无明显差异。与 OE 相比，MIE 术中出血量显著减少，引流总量显著减少，术后住院时间显著缩短，收获的淋巴结（LN）显著增多（均 P < 0.001）。MIE和OE在术后主要并发症和死亡率方面无明显差异。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组的3年OS和DFS分别为75.1%和66.5%，而OE组分别为66.9%和58.6%（OS：P = 0.04；DFS：P = 0.09）：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。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，其优势在于能收获更多的LN，改善cII期ESCC患者的术后恢复和生存率。

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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