Abstract：
BACKGROUND: Transcervical mediastinoscopic esophagectomy for esophageal and esophagogastric junction cancer is indicated in select institutions because of the complex surgical technique required and the unfamiliar surgical view compared with the standard transthoracic esophagectomy approach. This study was performed to compare the feasibility and efficacy of bilateral transcervical mediastinoscopic-assisted transhiatal laparoscopic esophagectomy (BTC-MATLE) with thoracolaparoscopic esophagectomy (TLE) for esophageal cancer.
METHODS: This study involved 392 consecutive patients with esophageal cancer who underwent curative minimally invasive esophagectomy with R0 resection (excluding salvage, conversion, and two-stage operations and open thoracotomy) at the National Cancer Center Hospital from 2017 to 2022. The patients underwent either BTC-MATLE or TE (32 and 360 consecutive patients, respectively). Propensity score-matching analysis was used to balance the baseline differences by covariates of age, performance status, and clinical stage.
RESULTS: There were statistically significant differences in age, performance status, cT factor, cN factor, cStage, preoperative treatment, and surgical history for respiratory disease. After propensity score-matching, these significant differences (excluding a surgical history of respiratory disease) were no longer statistically significant, and 27 patients were assigned to each group. The total operation time and the postoperative intensive care unit stay were significantly shorter in the BTC-MATLE than TLE group. There were no significant differences in overall postoperative complications or the three major postoperative complications of recurrent laryngeal nerve paralysis, anastomotic leakage, and pneumonia, even for patients whose preoperative pulmonary function indices (vital capacity and forced expiratory volume in 1 s) were significantly lower in the BTC-MATLE than TLE group. The numbers of total and thoracic harvested lymph nodes were significantly higher in the TLE than BTC-MATLE group; however, there was no significant difference in the recurrence rate between the two groups.
CONCLUSIONS: BTC-MATLE may provide the same feasibility and oncological outcomes as TLE even for patients with significantly lower pulmonary function.
METHODS: This study involved 392 consecutive patients with esophageal cancer who underwent curative minimally invasive esophagectomy with R0 resection (excluding salvage, conversion, and two-stage operations and open thoracotomy) at the National Cancer Center Hospital from 2017 to 2022. The patients underwent either BTC-MATLE or TE (32 and 360 consecutive patients, respectively). Propensity score-matching analysis was used to balance the baseline differences by covariates of age, performance status, and clinical stage.
RESULTS: There were statistically significant differences in age, performance status, cT factor, cN factor, cStage, preoperative treatment, and surgical history for respiratory disease. After propensity score-matching, these significant differences (excluding a surgical history of respiratory disease) were no longer statistically significant, and 27 patients were assigned to each group. The total operation time and the postoperative intensive care unit stay were significantly shorter in the BTC-MATLE than TLE group. There were no significant differences in overall postoperative complications or the three major postoperative complications of recurrent laryngeal nerve paralysis, anastomotic leakage, and pneumonia, even for patients whose preoperative pulmonary function indices (vital capacity and forced expiratory volume in 1 s) were significantly lower in the BTC-MATLE than TLE group. The numbers of total and thoracic harvested lymph nodes were significantly higher in the TLE than BTC-MATLE group; however, there was no significant difference in the recurrence rate between the two groups.
CONCLUSIONS: BTC-MATLE may provide the same feasibility and oncological outcomes as TLE even for patients with significantly lower pulmonary function.
摘要：
背景：由于与标准的经胸食管切除术方法相比，需要复杂的手术技术和不熟悉的手术视图，因此在某些机构中推荐了经纵隔镜下食管和食管胃交界处癌的食管切除术。本研究旨在比较双侧经颈纵隔镜辅助下腹腔镜食管癌切除术（BTC-MATLE）与胸腹腔镜食管癌切除术（TLE）的可行性和疗效。
方法：本研究涉及392例食管癌患者，这些患者接受了根治性微创食管切除术和R0切除（不包括抢救，转换，以及2017年至2022年在国家癌症中心医院进行的两阶段手术和开胸手术）。患者接受了BTC-MATLE或TE（连续32例和360例患者，分别)。倾向评分匹配分析用于平衡年龄协变量的基线差异，性能状态，和临床分期。
结果：年龄差异有统计学意义，性能状态，cT因子,cN因子，cStage,术前治疗,呼吸道疾病的手术史。在倾向得分匹配后，这些显著差异（排除呼吸系统疾病的手术史）不再具有统计学意义，27例患者被分配到每组.BTC-MATLE组的总手术时间和术后重症监护病房住院时间明显短于TLE组。喉返神经麻痹的术后总体并发症或三种主要并发症无显著差异，吻合口漏,还有肺炎,即使是BTC-MATLE组术前肺功能指标(肺活量和1s用力呼气量)明显低于TLE组的患者.TLE组的总淋巴结和胸部淋巴结的数量明显高于BTC-MATLE组；然而，两组的复发率差异无统计学意义。
结论：BTC-MATLE可能提供与TLE相同的可行性和肿瘤学结果，即使对于肺功能明显较低的患者也是如此。
方法：本研究涉及392例食管癌患者，这些患者接受了根治性微创食管切除术和R0切除（不包括抢救，转换，以及2017年至2022年在国家癌症中心医院进行的两阶段手术和开胸手术）。患者接受了BTC-MATLE或TE（连续32例和360例患者，分别)。倾向评分匹配分析用于平衡年龄协变量的基线差异，性能状态，和临床分期。
结果：年龄差异有统计学意义，性能状态，cT因子,cN因子，cStage,术前治疗,呼吸道疾病的手术史。在倾向得分匹配后，这些显著差异（排除呼吸系统疾病的手术史）不再具有统计学意义，27例患者被分配到每组.BTC-MATLE组的总手术时间和术后重症监护病房住院时间明显短于TLE组。喉返神经麻痹的术后总体并发症或三种主要并发症无显著差异，吻合口漏,还有肺炎,即使是BTC-MATLE组术前肺功能指标(肺活量和1s用力呼气量)明显低于TLE组的患者.TLE组的总淋巴结和胸部淋巴结的数量明显高于BTC-MATLE组；然而，两组的复发率差异无统计学意义。
结论：BTC-MATLE可能提供与TLE相同的可行性和肿瘤学结果，即使对于肺功能明显较低的患者也是如此。
