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Minimally invasive versus open esophagectomy for resectable thoracic esophageal cancer (NST 1502): a multicenter prospective cohort study

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机构: [1]Chinese Acad Med Sci & Peking Union Med Coll, Natl Clin Res Ctr Canc, Natl Canc Ctr, Dept Thorac Surg,Canc Hosp, Beijing, Peoples R China [2]Henan Canc Hosp, Dept Thorac Surg, Zhengzhou, Peoples R China [3]Fujian Med Univ Hosp, Dept Thorac Surg, Fuzhou, Peoples R China [4]Anyang Canc Hosp, Dept Thorac Surg, Anyang, Peoples R China [5]Fudan Univ, Zhongshang Hosp, Dept Thorac Surg, Shanghai, Peoples R China [6]Heilongjiang Canc Hosp, Dept Thorac Surg, Harbin, Peoples R China [7]Hunan Canc Hosp, Dept Thorac Surg, Changsha, Peoples R China [8]Tongji Univ, Tongji Hosp, Dept Thorac Surg, Wuhan, Peoples R China [9]Shanghai Chest Hosp, Dept Thorac Surg, Shanghai, Peoples R China [10]Sichuan Canc Hosp, Dept Thorac Surg, Chengdu, Peoples R China [11]Beijing Univ, Beijing Canc Hosp, Dept Thorac Surg, Beijing, Peoples R China [12]Anhui Med Univ, Affiliated Hosp 1, Dept Thorac Surg, Hefei, Peoples R China [13]Fourth Mil Med Univ, Dept Thorac Surg, Xian, Peoples R China [14]Sun Yat Sen Univ, Canc Ctr, Dept Thorac Surg, Guangzhou, Peoples R China [15]Liaoning Canc Hosp, Dept Thorac Surg, Shenyang, Peoples R China [16]Zhejiang Canc Hosp, Dept Thorac Surg, Hangzhou, Peoples R China [17]Anhui Prov Hosp, Dept Thorac Surg, Hefei, Peoples R China [18]Fujian Med Univ, Fujian Canc Hosp, Dept Thorac Surg, Fuzhou, Peoples R China [19]Tianjin Peoples Hosp, Dept Thorac Surg, Tianjin, Peoples R China
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关键词: Minimally invasive esophagectomy Open esophagectomy Lymphadenectomy Postoperative recovery Survival

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Background: Whether minimally invasive esophagectomy (MIE) is superior to open esophagectomy (OE) in the treatment of esophageal squamous cell carcinoma (ESCC) is still uncertain. Therefore, this multicenter prospective study aimed to compare MIE with OE in postoperative parameters and long-term survival. Methods: All hospitalized patients with cT1b-3N0-1M0 thoracic ESCC treated by MIE or OE were enrolled from 19 selected centers from April 1, 2015 to December 31, 2018. The propensity score matching (PSM) was performed to minimize the selection bias. The basic clinicopathological characteristics and 3-year overall survival (OS) as well as disease-free survival (DFS) of two groups were compared by R version 3.6.2. Results: MIE were performed in 1,387 patients and OE in 335 patients. 335 cases in each group were finally matched by PSM, and no significant differences in the essential demographic characteristics were observed be-tween the MIE and OE groups after PSM. Compared with OE, MIE had significantly less intraoperative bleeding, less total drainage volume, shorter postoperative hospital stay, and harvested significantly more lymph nodes (LNs) (all P < 0.001). There were no significant differences in the major postoperative complications and death rates between MIE and OE. The 3-year OS and DFS were 77.0% and 68.1% in the MIE group versus 69.3% and 60.9% in the OE group (OS: P = 0.03; DFS: P = 0.09), and the rates were 75.1% and 66.5% in the MIE group versus 66.9% and 58.6% in the OE group for stage cII patients (OS: P = 0.04, DFS: P = 0.09), respectively.Conclusions: Compared with OE, MIE is a safe and effective treatment approach with similar mortality and morbidity. It has the advantages in harvesting more LNs, improving postoperative recovery and survival of stage cII ESCC patients.

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第一作者机构: [1]Chinese Acad Med Sci & Peking Union Med Coll, Natl Clin Res Ctr Canc, Natl Canc Ctr, Dept Thorac Surg,Canc Hosp, Beijing, Peoples R China
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