Survival comparison between open and thoracoscopic esophagectomy for node-negative esophageal squamous cell cancer: an ambispective cohort study.

Autor: Jia X; Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Science Avenue, High-tech Development Zone, Zhengzhou, 450001, Henan, China., Ren T; Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Science Avenue, High-tech Development Zone, Zhengzhou, 450001, Henan, China., Chen P; Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming Road, Jinshui District, Zhengzhou, 450008, Henan, China., Xin X; Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Science Avenue, High-tech Development Zone, Zhengzhou, 450001, Henan, China., Zhang Y; Department of Medical Record, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, Henan, China., Yang Y; Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Science Avenue, High-tech Development Zone, Zhengzhou, 450001, Henan, China. ylyang377@zzu.edu.cn.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2024 Dec; Vol. 38 (12), pp. 7341-7351. Date of Electronic Publication: 2024 Oct 21.
DOI: 10.1007/s00464-024-11302-y
Abstrakt: Background: It is controversial whether there is a survival difference between open esophagectomy (OE) and thoracoscopic esophagectomy (TE) for esophageal cancer (EC). Therefore, this study aimed to compare the differences in survival and safety between two surgical approaches in patients with node-negative esophageal squamous cell carcinoma (ESCC).
Methods: This ambispective cohort study included 1104 patients with node-negative ESCC who received OE or TE treatment at a Grate-A tertiary hospital in Henan Province between January 2015 and December 2016. The primary endpoint was 5-year overall survival (OS) and disease-free survival (DFS), and the secondary endpoint was surgical safety. Multivariable Cox regression analysis was used to analyze the effect of surgical approaches on OS and DFS, and propensity score matching (PSM) was performed to match confounding factors between two groups.
Results: Patients were followed up ranged from 1.03 to 91.60 months, with a median follow-up time of 67.37 months. Kaplan-Meier survival analysis showed statistically significant differences between OE and TE in OS (70.05% vs 83.73%, P < 0.001) and DFS (67.15% vs 77.76%, P < 0.001). Furthermore, multivariate Cox regression analysis also demonstrated significant differences in long-term survival between the two groups (OS, HR (95% CI): 0.54 (0.41, 0.70); DFS, HR (95% CI): 0.68 (0.54, 0.86)). TE was associated with a reduction in intraoperative bleeding (median: 100 ml vs. 200 ml, P < 0.001), and an increase in the number of lymph nodes dissection (median: 23 vs. 28, P < 0.001). Similar results were found after PSM.
Conclusion: In a selected cohort of patients with node-negative ESCC, TE surgical treatment was safer and had better long-term survival outcomes compared to OE. This provided corresponding clinical guidance to enhance survival benefits for patients. In the future, we hope to further explore the reasons for TE achieving higher survival rates.
Competing Interests: Declarations. Disclosures: Xiaocan Jia, Tongtong Ren, Peinan Chen, Xin Xin, Yi Zhang, and Yongli Yang have no conflicts of interest or financial ties to disclose. Ethical approval: All data collection and analysis in this study were reviewed and approved by the Ethics Committee of Zhengzhou University (ZZUIRB2022-99). Consent to participate: Informed written consent was obtained from each patient. Patient consent for publication: Each patient provided informed consent, willingly agreeing to have their information published.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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