Comparisons of minimally invasive esophagectomy and open esophagectomy in lymph node metastasis/dissection for thoracic esophageal cancer

Background:The study aimed to clarify the characteristics of lymph node metastasis(LNM)and to compare the oncologic outcomes of minimally invasive esophagectomy(MIE)with open esophagectomy(OE)in terms of lymph node dissection(LND)in thoracic esophageal cancer patients.Methods:The data from esophageal cancer patients who underwent MIE or OE from January 2016 to January 2019 were retrospectively reviewed.The characteristics of LNM in thoracic esophageal cancer were discussed,and the differences in numbers of LND,LND rate,and LNM rate/degree of upper mediastinum between MIE and OE were compared.Results:For overall characteristics of LNM in 249 included patients,the highest rate of LNM was found in upper mediastinum,while LNM rate in middle and lower mediastinum,and abdomen increased with the tumor site moving down.The patients were divided into MIE(n=204)and OE groups(n=45).In terms of number of LND,there were significant differences in upper mediastinum between MIE and OE groups(8[5,11]vs.5[3,8],P<0.001).The comparative analysis of regional lymph node showed there was no significant difference except the subgroup of upper mediastinal 2L and 4L group(3[1,5]vs.0[0,2],P<0.001 and 0[0,2]vs.0,P=0.012,respectively).Meanwhile,there was no significant difference in terms of LND rate except 2L(89.7%[183/204]vs.71.1%[32/45],P=0.001)and 4L(41.2%[84/204]vs.22.2%[10/45],P=0.018)groups.For LNM rate of T3 stage,there was no significant difference between MIE and OE groups,and the comparative analysis of regional lymph node showed that there was no significant difference except 2L group(11.1%[5/45]vs.38.1%[8/21],P=0.025).The LNM degree of OE group was significantly higher than that of MIE group(27.2%[47/173]vs.7.6%[32/419],P<0.001),and the comparative analysis of regional LNM degree showed that there was no significant difference except 2L(34.7%[17/49]vs.7.7%[13/169],P<0.001)and 4L(23.8%[5/21]vs.3.9%[2/51],P=0.031)subgroups.Conclusion:MIE may have an advantage in LND of upper mediastinum 2L and 4L groups,while it was similar to OE in other stations of LND.

Outcomes of curative esophageal cancer surgery in elderly:A metaanalysis

BACKGROUND An increasing number of older patients is undergoing curative,surgical treatment of esophageal cancer.Previous meta-analyses have shown that older patients suffered from more postoperative morbidity and mortality compared to younger patients,which may lead to patient selection based on age.However,only studies including patients that underwent open esophagectomy were included.Therefore,it remains unknown whether there is an association between age and outcome in patients undergoing minimally invasive esophagectomy.AIM To perform a systematic review on age and postoperative outcome in esophageal cancer patients undergoing esophagectomy.METHODS Studies comparing older with younger patients with primary esophageal cancer undergoing curative esophagectomy were included.Meta-analysis of studies using a 75-year age threshold are presented in the manuscript,studies using other age thresholds in the Supplementary material.MEDLINE,Embase and the Cochrane Library were searched for articles published between 1995 and 2020.Risk of bias was assessed with the Newcastle-Ottawa Scale.Primary outcomes were anastomotic leak,pulmonary and cardiac complications,delirium,30-and 90-d,and in-hospital mortality.Secondary outcomes included pneumonia and 5-year overall survival.RESULTS Seven studies(4847 patients)using an age threshold of 75 years were included for meta-analysis with 755 older and 4092 younger patients.Older patients(9.05%)had higher rates of 90-d mortality compared with younger patients(3.92%),(confidence interval=1.10-5.56).In addition,older patients(9.45%)had higher rates of in-hospital mortality compared with younger patients(3.68%),(confidence interval=1.01-5.91).In the subgroup of 2 studies with minimally invasive esophagectomy,older and younger patients had comparable 30-d,90-d and in-hospital mortality rates.CONCLUSION Older patients undergoing curative esophagectomy for esophageal cancer have a higher postoperative mortality risk.Minimally invasive esophagectomy may be important for minimizing mortality in older patients.