pT1b期食管鳞状细胞癌开放手术与微创食管切除术后预后分析

Prognostic analysis of pT1b esophageal squamous cell carcinoma after open or minimally invasive esophagectomy

目的比较微创食管切除术与传统开放食管切除术对pT1b期食管鳞状细胞癌(ESCC)患者近远期疗效之间的差异。方法回顾性分析2015~2018年于苏北人民医院胸外科行手术治疗并且术后病理确诊为pT1b期ESCC 162例患者的临床病理资料。根据手术方式分为微创手术(MIE)组和开放手术(OE)组。其中OE组共76例,男55例、女21例,平均年龄(63.3±5.6)岁;MIE组共86例,男60例、女26例,平均年龄(64.7±6.1)岁。比较两组患者的围术期资料并进行随访。采用Kaplan-Meier和log-rank检验对两组生存曲线进行比较,并利用Cox比例风险回归模型分析预后因素。结果与OE组相比,MIE组的术中出血量更少[(119.8±70.0)mL vs.(210.5±136.2)mL,P<0.001]、术中清扫淋巴结数量更多[(19.1±7.4)枚vs.(13.8±5.9)枚,P<0.001]、术后肺部感染发生率更低(9.3%vs.21.1%,P=0.036),但MIE组的手术时间[(240.0±52.4)min vs.(179.5±35.7)min,P<0.001]更长。162例患者中21例出现淋巴结转移,淋巴结转移率13.0%。至随访结束时共有19例患者死亡,术后1年、3年、5年总生存率(OS)分别为97.5%、88.8%和82.9%;31例患者出现复发转移,术后1年、3年、5年无病生存率(DFS)分别为95.1%、80.9%和75.6%;两组的OS和DFS差异无统计学意义。OS的多因素Cox回归分析结果发现淋巴结转移、吻合口瘘和乳糜胸是影响患者OS的独立危险因素。DFS的多因素Cox回归分析结果发现淋巴结转移、吻合口瘘、乳糜胸和脉管癌栓是影响患者DFS的独立危险因素。结论MIE可以达到与OE相同的远期疗效,并且术中出血量更少、清扫的淋巴结数目更多、术后肺部感染发生率更低,但手术时间更长。

Objective To compare the short-term and long-term effects of minimally invasive esophagectomy(MIE)and traditional open esophagectomy(OE)in patients with stage T1b esophageal squamous cell carcinoma(ESCC).Methods We retrospectively analyzed the clinical pathology data of 162 patients undergoing thoracic surgery at Northern Jiangsu People's Hospital from 2015 to 2018 whose pathological diagnosis was stage pT1b ESCC.According to the surgical approach,they were divided into MIE group and OE group.There were 55 males and 21 females in the OE group,with an average age of 63.3±5.6 years,and 60 males and 26 females in the MIE group,with an average age of 64.7±6.1 years.The preoperative,intraoperative and postoperative data of the two groups were compared and followed up.Survival data were compared using Kaplan-Meier and log-rank tests between the two groups,and Cox proportional hazard regression models were used to analyze prognostic factors.Results Compared with the OE group,the intraoperative bleeding volume of the MIE group was less(119.8±70.0 mL vs.210.5±136.2 mL,P<0.001),and the lymph nodes dissected during the operation were more(19.1±7.4 vs.13.8±5.9,P<0.001),the rate of postoperative pulmonary infections was lower(9.3%vs.21.1%,P=0.036),but the operation time was longer(240.0±52.4 min vs.179.5±35.7 min,P<0.001).Twenty-one patients had lymph node metastasis,and the lymph node metastasis rate was 13.0%.At the end of the follow-up,19 patients died,and the overall survival(OS)at 1 year,3 years,and 5 years after operation were 97.5%,88.8%and 82.9%,respectively;31 patients had recurrence and metastasis,and the disease-free survival(DFS)rate at 1 year,3 years,and 5 years after operation was 95.1%,80.9%and 75.6%.There was no significant difference in OS and DFS between the two groups.Multivariate Cox regression analysis of OS found that lymph node metastasis,anastomotic fistula and chylothorax were independent risk factors for OS.Multivariate Cox regression analysis of DFS found that lymph node metastasis,anastomotic fistula,chylothorax,and vascular cancer thrombus were independent risk factors for OS.Conclusion MIE can achieve the same long-term effects as OE,with less intraoperative bleeding,more lymph nodes dissected,and lower incidence of postoperative pulmonary infections,but it takes longer operation time.