倾向评分匹配后微创Ivor-Lewis术与微创McKeown术治疗中下段食管鳞癌的近、远期疗效比较

Comparison of the short-term and long-term outcomes between minimally invaisive Ivor-Lewis and minimally invaisive McKeown esophagectomy for middle or lower esophageal squamous cell carcinoma after propensity score matching analysis

目的比较微创Ivor-Lewis和微创McKeown术治疗胸中下段食管鳞癌近、远期疗效。方法回顾性分析安徽省立医院胸外科2010年8月至2014年3月胸中下段食管鳞癌行微创手术的连续268例患者资料,根据手术方式分为微创Ivor-Lewis组和微创McKeown组,用倾向评分匹配方法两组各纳入81例后比较近、远期疗效。结果微创Ivor-Lewis组在手术时间、喉返神经旁淋巴结清扫数目、肺部感染及吻合口瘘发生率低于微创McKeown组(P<0.05)。微创Ivor-Lewis组1、3、5年生存率分别为87.7%、59.2%、45.9%,微创McKeown组患者1、3、5年生存率分别为86.4%、58.7%、42.8%,两组5年生存率差异无统计学意义。结论对于胸中下段食管鳞癌,微创Ivor-Lewis和微创McKeown手术在远期生存上无明显差异,微创Ivor-Lewis在减少手术时间、肺部感染和吻合口瘘方面有优势,但微创McKeown在喉返神经旁淋巴结清扫方面有优势。

Objective The aim of our study was to compare the short-term and long-term outcomes between minimally invaisive Ivor-Lewis esophagectomy(MIILE)and minimally invasive McKeown esophagectomy(MIME)for squamous cell carcinoma of middle and lower esophagus.Methods The data of 268 patients diagnosed with middle and lower esophageal spuamous cell carcinoma who had received MIILE or MIME between August 2010 and March 2014 at department of thoracic surgery,The First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),was analyzed retrospectively.We divided the subjects into two groups according to the mode of the operation,each group was identified 81 patients after propensity score matching.We were using t test,χ2 test,Kaplan-Meier curve and Log-rank test to compare preoperative data and overall survival of the two groups.Results Compared with MIME,MIILE had lower complication in pulmonary infection and anastomotic fistula,also had less operating time,whereas MIME had an advantage in the number of lymph nodes dissection adjacent to recurrent laryngeal nerve(P<0.05).The 1-year、3-year、5-year survival rate of MIILE were 87.7%、59.2%、45.9%,and the 1-year、3-year、5-year survival rate of MIME were 86.4%、58.7%、42.8%.There were no significant difference between two groups in 5-year survival rate.Conclusion For squamous cell carcinoma of middle and lower esophagus,minimally invasive Ivor-Lewis esophagectomy and minimally invasive McKeown have no significant difference in long-term survival,but minimally invasive Ivor-Lewis esophagectomy has advantages in reduce the operating time,decrease pulmonary infection and anastomotic fistula during perioperative period.Nevertheless minimally invasive McKeown has an advantage in dissection of the lymph nodes adjacent to recurrent laryngeal nerve.