Analysis of therapeutic effects between minimally invasive esophagectomy and open triple-incision esopha-gectomy

Abstract

Objective To investigate the clinical efficacy of minimally invasive esophagectomy and open triple-incision esophagectomy for esophageal cancer (EC). Methods The retrospective cohort study was conducted. The clinicopathological data of 454 EC patients who were admitted to the Tianjin Medical University Cancer Institute and Hospital from January 2012 to September 2016 were collected. Of 454 patients, 229 undergoing thoracoscopic esophagectomy (194) or combined thoracoscopic + laparoscopic esophagectomy (35) were allocated into the minimally invasive group, and 225 undergoing open triple-incision esophagectomy in the left cervical, right chest and epigastric regions were allocated into the open group. Observation indicators: (1) intraoperative situations; (2) postoperative recovery situations; (3) stratified analysis; (4) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect the postoperative survival up to October 2017. Measurement data with normal distribution were represented as ±s, and t test was used for comparison between groups. Measurement data with skewed distribution were described as M (range), non-parametric test was used for comparison between groups. Count data were expressed as percentage, and the chi-square test or fisher exact probability method were used to test comparison between groups. Kaplan-Meier method was used to calculate survival rate and draw survival curve. Log-rank test was used for survival analysis. Results (1) Intraoperative situations: operation time, numbers of upper mediastina lymph node dissected and right laryngeal nerve lymph node dissected in stage 0-Ⅱ of TNM staging and numbers of neck lymph nodes dissected in stage Ⅲ of TNM staging were respectively (307±70)minutes, 4 (range, 0-18), 2 (range, 0-10), 0 (range, 0-24) in the minimally invasive group and (267±49)minutes, 3 (range, 0-15), 1 (range, 0-7), 0 (range, 0-46) in the open group, with statistically significant differences between groups (t=7.071, Z=-2.207, -2.717, -1.969, P 0.05). (4) Follow-up and survival situations: of 454 patients, 415 were followed up for 1-62 months, with a median time of 28 months. Among the 415 patients, operation time ≥ 3 years was detected in 162 patients, (77 in the minimally invasive group and 85 in the open group), and 3-year cumulative survival rates of the minimally invasive and open groups were 68.1% and 53.8%, showing no statistically significant difference between groups (χ2=3.293, P>0.05). Further subgroup analysis showed that postoperative 3-year cumulative survival rates of patients with the stage Ⅰ-Ⅱ and Ⅲ of TNM staging were respectively 82.1%, 53.7% in the minimally invasive group and 62.6%, 48.6% in the open group, showing no statistically significant difference between groups (χ2=2.664, 0.382, P>0.05). Conclusion Minimally invasive esophagectomy has some characteristics of less surgical trauma postoperative complications, and its resection effect is comparable to open esophagectomy. Key words: Esophageal neoplasms; Lymph node dissection; Survival rate; Thoracoscopy; Laparoscopy