Objectives: To compare the short-, mid-, and long-term outcomes in patients with esophageal cancer between minimally invasive esophagectomy via Sweet approach in combination with cervical mediastinoscopy (MIE-SM) and minimally invasive esophagectomy via McKeown approach (MIE-MC), and to evaluate the value of MIE-SM in the surgical treatment of esophageal cancer.
Methods: A prospective, nonrandomized study was adopted. A total of 65 esophageal cancer patients after MIE-SM and MIE-MC from June 2014 to May 2016 were included. Among them, 33 patients underwent MIE-SM and 32 patients underwent MIE-MC. Short-term outcomes (including the duration of surgery, intraoperative blood loss volume, ICU stay time, postoperative complications, postoperative hospital stay, reoperation, open surgery, number of dissected lymph nodes, and 30-day mortality), mid-term outcomes, [including Quality of Life Core Questionnaire (QLQ-C30) and the esophageal site-specific module (QLQ-OES18)], long-term outcomes [including overall survival and disease-free survival] were compared between the 2 groups.
Results: Radical resection (R0) were achieved in all patients. There were no significant differences in the duration of surgery, intraoperative blood loss volume, ICU stay time, postoperative complications, and postoperative hospital stay between the 2 groups (all P>0.05). More lymph nodes were dissected in the MIE-SM group (24.1±7.3) than those in the MIE-MC group (17.8±5.0, P<0.001). The emotional function, global health status scale scores in QLQ-C30 scale in the MIE-SM group were significantly higher than those in the MIE-MC group (P=0.025, P<0.001, respectively), and the pain score in the MIE-SM group was significantly lower than that in the MIE-MC group (P=0.013). QLQ-OES18 results showed that the pain score in the MIE-SM group was significantly lower than that in the MIE-MC group (P=0.021). Survival analysis showed that the overall survival and disease-free survival were similar between the 2 groups.
Conclusions: MIE-SM appears to be a safe surgical approach, which may get better quality of life, suffer less pain, and can achieve the same therapeutic effect as MIE-MC. Therefore, MIE-SM should be considered as a valuable approach for the treatment of middle and lower esophageal cancer.
目的: 经Sweet入路联合纵隔镜微创食管切除术(MIE-SM)的报道较少。本研究旨在比较MIE-SM与经McKeown入路微创食管切除术(MIE-MC)治疗食管癌的近期、中期和长期疗效，评价MIE-SM在食管癌外科治疗中的价值。方法: 采用前瞻性非随机研究。纳入2014年6月至2016年5月行MIE-SM或MIE-MC术的食管癌患者65例，其中33例接受MIE-SM治疗，32例接受MIE-MC治疗。比较患者短期疗效(包括手术时间、术中失血量、ICU住院时间、术后并发症、术后住院时间、再次手术、开放手术、淋巴结清扫数和30 d病死率)、中期疗效[包括生活质量量表(quality of life questionnaire，QLQ)核心量表(C30)和食管癌补充量表(OES-18)，即QLQ-C30和QLQ-OES18]和长期疗效(总生存率和无病生存率)。结果: 所有患者均获得根治性切除(R0)。两组患者术后住院时间、术中出血量差异无统计学意义(均P>0.05)。MIE-SM组淋巴结清扫率(24.1±7.3)明显多于MIE-MC组(17.8±5.0，P<0.001)。QLQ-C30结果显示：MIE-SM组的情绪功能、全身健康状况量表评分均明显高于MIE-MC组(分别P=0.025，P<0.001)，疼痛评分明显低于MIE-MC组(P=0.013)。QLQ-OES18结果显示：MIE-SM组的疼痛评分明显低于MIE-MC组(P=0.021)。生存分析显示两组的总生存率和无病生存率相似。结论: MIE-SM是治疗食管癌的一种安全且有效的途径，可获得与MIE-MC相同的治疗效果，而且与MIE-MC手术相比，患者术后生活质量好，痛苦少。.
目的: 经Sweet入路联合纵隔镜微创食管切除术(MIE-SM)的报道较少。本研究旨在比较MIE-SM与经McKeown入路微创食管切除术(MIE-MC)治疗食管癌的近期、中期和长期疗效，评价MIE-SM在食管癌外科治疗中的价值。
方法: 采用前瞻性非随机研究。纳入2014年6月至2016年5月行MIE-SM或MIE-MC术的食管癌患者65例，其中33例接受MIE-SM治疗，32例接受MIE-MC治疗。比较患者短期疗效(包括手术时间、术中失血量、ICU住院时间、术后并发症、术后住院时间、再次手术、开放手术、淋巴结清扫数和30 d病死率)、中期疗效[包括生活质量量表(quality of life questionnaire，QLQ)核心量表(C30)和食管癌补充量表(OES-18)，即QLQ-C30和QLQ-OES18]和长期疗效(总生存率和无病生存率)。
结果: 所有患者均获得根治性切除(R0)。两组患者术后住院时间、术中出血量差异无统计学意义(均P>0.05)。MIE-SM组淋巴结清扫率(24.1±7.3)明显多于MIE-MC组(17.8±5.0，P<0.001)。QLQ-C30结果显示：MIE-SM组的情绪功能、全身健康状况量表评分均明显高于MIE-MC组(分别P=0.025，P<0.001)，疼痛评分明显低于MIE-MC组(P=0.013)。QLQ-OES18结果显示：MIE-SM组的疼痛评分明显低于MIE-MC组(P=0.021)。生存分析显示两组的总生存率和无病生存率相似。
结论: MIE-SM是治疗食管癌的一种安全且有效的途径，可获得与MIE-MC相同的治疗效果，而且与MIE-MC手术相比，患者术后生活质量好，痛苦少。
Keywords: McKeown approach; QLQ-C30; QLQ-OES18; Sweet approach; esophageal cancer; mediastinoscopy; minimally invasive esophagectomy.