Sweet手术与Ivor鄄Lewis手术治疗中下段食管鳞癌的疗效比较

Efficacy comparison of Sweet versus Ivor-Lewis esophagectomy in the treatment of middle-lower esophageal squamous cell carcinoma

目的：比较Ivor-Lewis与Sweet手术治疗中下段食管癌的近期疗效和远期生存。方法回顾性分析2007年1月至2014年12月间在复旦大学附属中山医院胸外科接受 Sweet或Ivor-Lewis手术的1308例中下段食管鳞癌患者的病例资料，其中Sweet手术组1021例，Ivor-Lewis手术组287例。比较两组患者淋巴结清扫和转移情况、术后并发症发生率及远期生存。结果两组患者基线资料比较，差异均无统计学意义（均P ＞0．05）。 Sweet手术组患者平均淋巴结清扫数目较Ivor-Lewis手术组减少（19．3枚／例比20．8枚／例，P ＝0．030）。围手术期指标的比较，Sweet手术组术后伤口感染发生率较Ivor-Lewis手术组降低[3．2％（33／1021）比8．0％（23／287），P =0．000]，胃排空延迟出现概率降低[1．9％（19／1021）比5．2％（15／287），P＝0．002]，平均术后住院时间缩短（14．7 d比17．2 d，P =0.029）。 Sweet手术组与Ivor-Lewis手术组术后5年生存率的差异无统计学意义（54．0％比56．9％，P ＝0．873）。分层分析显示，在Ⅰ期和Ⅲ期患者中，两组患者5年生存率的差异无统计学意义（均P ＞0．05）；但在Ⅱ期患者中，Sweet手术组5年生存率明显低于Ivor-Lewis手术组（56．4％比70．4％，P ＝0．039）。结论在中下段食管鳞癌患者的治疗中，Sweet手术在减少术后胃排空障碍和伤口感染方面上具有一定的优势。尽管Ivor-Lewis手术比Sweet手术能清扫更多的淋巴结，但两种手术方式可获得相似的远期生存。因此，Sweet手术依然有一定的临床应用价值，但对于Ⅱ期患者应谨慎选择。

Objective To compare the short-term efficacy and long-term survival between Sweet and Ivor-Lewis esophagectomy for patients with middle-lower esophageal squamous cell carcinoma. Methods Clinicopathologic data of 1 308 patients with middle-lower esophageal squamous cell carcinoma undergoing Sweet or Ivor-Lewis procedures in our department from January 2007 to December 2014 were retrospectively analyzed, including 1 021 patients of Sweet operation （Sweet group） and 287 patients of Ivor-Lewis operation （Ivor-lewis group）. Lymph node clearance, lymphatic metastasis, postoperative complication morbidity and long-term survival were compared between the two groups. Results There were no significant differences in baseline data between the two groups （all P 〉 0.05）. There were more lymph nodes resected during the Ivor-Lewis procedure compared with the Sweet procedure （20.8 vs.19.3, P=0.030）. Compared with Ivor-Lewis group, the incidence of wound infection in Sweet group was significantly lower [（3.2%（33/1 021） vs. 8.0%（23/287）, P = 0.000]. Sweet group had a significantly lower rate of delayed gastric emptying [1.9%（19/1 021） vs. 5.2%（15/287）, P=0.002] and significantly shorter hospital stay （14.7 days vs. 17.2 days, P=0.029）. With respect to other postoperative complications, such as pulmonary complications, cardiac events, anastomotic leakage, vocal cord palsy, chylothorax and pyothorax, the differences between the two groups were not statistically significant. The 5-year survival rate was not significantly different between the two group （54.0% vs. 56.9%, P = 0.873）. Stratified analysis based on TNM staging showed that no significant difference of 5-year survival rate was found between the two groups in stageⅠ and stage Ⅲ patients （P 〉 0.05）, while the 5-year survival rate of stageⅡ patients in Sweet group was significantly lower than that in Ivor-Lewis group （56.4%% vs. 70.4%, P = 0.039）. Conclusions For patients with middle-lower esophageal squamous cell carcinoma , Sweet procedure has certain superiority regarding the incidence of wound infection and delayed gastric emptying compared with the Ivor-Lewis procedure. Ivor-Lewis esophagectomy can harvest more lymph nodes. The 5-year survival rate of these two procedures is similar. Sweet procedure is still valuable in clinical practice , especially for stageⅠ and stageⅢpatients, while it requires thorough considerations for stageⅡ patients.