Comparison of Ivor Lewis esophagectomy and Sweet esophagectomy for the treatment of middle-lower esophageal squamous cell carcinoma

Comparative study of acute and chronic pain after inflatable videoasisted MediastinoscopicTranshiatal esophagectomy and minimally invasive McKeown Esophagectomy:A propensity score matching analysis

Objective

The short-term quality of life of patients can be enhanced by performing Inflatable Video-Assisted Mediastinoscopic Transhiatal Esophagectomy (IVMTE). Nevertheless, there is limited research on how it impacts postoperative acute and chronic pain in individuals diagnosed with esophageal cancer.Hence, this research aimed to examine the impact of IVMTE and minimally invasive Mckeown esophagectomy (MIME) on the occurrence of acute and chronic pain following surgery in individuals diagnosed with esophageal cancer.

Methods

A retrospective, propensity score matching analysis was adopted. In total, 133 patients with esophageal cancer who underwent IVMTE and MIME between January 2020 and December 2021 were part of the study. Among them, 38 patients underwent IVMTE and 95 patients underwent MIME. Following the propensity score matching analysis, 36 patients were included in each group. Patients' postoperative pain was evaluated using the numerical rating scale (NRS).

Results

The IVMTE group (Group A) had significantly reduced operation time and intraoperative blood loss compared to the MIME group (Group B) (P < 0.05). NRS scores on the 1st, 2nd, 3rd, and 7th days after surgery, as well as on the 3rd and 6th months post-surgery, were notably reduced in the IVMTE group (Group A) compared to the MIME group (Group B) (P < 0.05). Univariate and multivariate analysis showed that chronic pain occurred postoperative 3rd months was related to the operation methods (P < 0.05). Univariate analysis showed that chronic pain occurred postoperative 6th months was related to the operation time, postoperative 14th days NRS scores and operation methods (P < 0.05). Multivariate analysis showed that chronic pain occurred postoperative 6th months was related to the operation methods (P < 0.05).

Conclusion

The results showed that the operation methods were the main risk factors for postoperative chronic pain. The compared with MIME, IVMTE can further reduce the acute and chronic pain of patients with esophageal cancer.

Establishment and validation of a prognostic risk classification for patients with stage T1-3N0M0 esophageal squamous cell carcinoma

INTRODUCTION

At present, clinical factors and hematological indicators have been proved to have great potential in predicting the prognosis of cancer patients, and no one has combined these two valuable indicators to establish a prognostic model for esophageal squamous cell carcinoma (ESCC) patients with stage T1-3N0M0 after R0 resection. To verify, we aimed to combine these potential indicators to establish a prognostic model.

METHODS

Stage T1-3N0M0 ESCC patients from two cancer centers (including training cohort: N = 819, and an external validation cohort: N = 177)-who had undergone esophagectomy in 1995-2015 were included. We integrated significant risk factors for death events by multivariable logistic regression methods and applied them to the training cohort to build Esorisk. The parsimonious aggregate Esorisk score was calculated for each patient; the training set was divided into three prognostic risk classes according to the 33rd and 66th percentiles of the Esorisk score. The association of Esorisk with cancer-specific survival (CSS) was assessed using Cox regression analyses.

RESULTS

The Esorisk model was: [10 + 0.023 × age + 0.517 × drinking history - 0.012 × hemoglobin-0.042 × albumin - 0.032 × lymph nodes]. Patients were grouped into three classes-Class A (5.14-7.26, low risk), Class B (7.27-7.70, middle risk), and Class C (7.71-9.29, high risk). In the training group, five-year CSS decreased across the categories (A: 63%; B: 52%; C: 30%, Log-rank P < 0.001). Similar findings were observed in the validation group. Additionally, Cox regression analysis showed that Esorisk aggregate score remained significantly associated with CSS in the training cohort and validation cohort after adjusting for other confounders.

CONCLUSIONS

We combined the data of two large clinical centers, and comprehensively considered their valuable clinical factors and hematological indicators, established and verified a new prognostic risk classification that can predict CSS of stage T1-3N0M0 ESCC patients.

Left versus right approach for middle and lower esophageal squamous cell carcinoma: A propensity score-matched study

Background

Despite superior short-term outcomes, there is considerable debate about the oncological efficacy of the left approach esophagectomy for middle and lower squamous esophageal carcinoma (ESCC). A propensity score-matched retrospective study was conducted to evaluate the left approach's short- and long-term effects.

Methods

We recorded data from patients with ESCC who underwent curative resection via the left or right approach between January 2010 and December 2015. Propensity score matching (PSM) was performed, and maximally selected rank statistics (MSRS) were utilized to determine the appropriate number of lymph nodes to resect during esophagectomy.

Results

One hundred and forty-eight ESCC patients underwent esophagectomy via the right approach, and 108 underwent the left approach esophagectomy. After PSM, the left approach esophagectomy showed statistically significant superiority in operative time and time to oral intake, and there was a trend toward a shorter length of hospital stay. Fewer cervical, upper thoracic, and recurrent laryngeal nerve lymph nodes were harvested via the left approach than the right approach; the total number of lymph nodes harvested via the left and right approaches was similar. Similar long-term survival outcomes were achieved. MSRS suggested that at least 25 lymph nodes are needed to be resected during esophagectomy to improve survival in N0 patients.

Conclusions

The left approach esophagectomy might facilitate postoperative recovery in patients with middle and lower ESCC. With adequate lymphadenectomy, the left approach esophagectomy might achieve similar long-term outcomes for middle and lower ESCC patients.

Enhanced recovery after surgery improves short-term outcomes in patients undergoing esophagectomy

BACKGROUND

Enhanced recovery after surgery (ERAS) is a perioperative management protocol that aims to accelerate patient recovery. This study aimed to evaluate its benefits in patients with resectable esophageal cancer.

METHODS

This retrospective study compared patients before (January 2013 to December 2016) and after (June 2018 to December 2020) ERAS protocol implementation in our hospital. A propensity score-matched (PSM) analysis was used to compare short-term surgical outcomes between ERAS and non-ERAS groups. After PSM, each group included 243 patients.

RESULTS

There were significant differences in hospital length of stay after surgery (7.40 vs. 11.17 days, P<.001) and hospitalization cost (¥69380 vs. ¥78075, P<.001) between the ERAS and non-ERAS groups. The time to chest tube removal (4.91 vs. 7.16 days, P<.001) and first bowel movement (2.87 vs. 3.97 days, P<.001) was significantly shorter in the ERAS group. However, there was no significant difference in total postoperative complication morbidity (20.2% vs. 25.1%, P=0.193). The complication of postoperative atelectasis or pneumonia was significantly lower in the ERAS group (P=0.003), but there was no significant difference in occurrence of ≥Grade III complications between the two groups (12.3% vs. 11.5%, P=0.889).

CONCLUSIONS

We demonstrated that ERAS could reduce the hospital stay, numerical pain scores, and hospitalization costs without increasing postoperative complication and readmission. Furthermore, subgroup analyses revealed that ERAS was safe for older people (>70 years old).

Survival risk prediction model for patients with pT1-3 N0M0 esophageal squamous cell carcinoma after R0 esophagectomy with two-field lymphadenectomy for therapeutic purposes

BACKGROUND

The overall survival (OS) remains unsatisfactory in patients with esophageal squamous cell carcinoma (ESCC) after extended esophagectomy with two-field lymphadenectomy. Therefore, this retrospective study aimed to identify the risk factors that contribute to the low survival of patients with pT_1-3N₀M₀ ESCC.

METHODS

Patients with pT_1-3N₀M₀ ESCC who only underwent R0 esophagectomy with two-field lymphadenectomy in our department from January 2008 to December 2012 were retrospectively enrolled in this study and medical records were reviewed. Postoperative OS, disease-free survival (DFS), recurrence-free survival (RFS), and locoregional recurrence-free survival (LRFS) were analyzed sequentially.

RESULTS

This study recruited a total of 488 patients, whose follow-up visits were completed at the end of December 2019. The five-year OS, DFS, RFS and LRFS rates were 62.1, 53.1, 58.3 and 65.6%, respectively. Multivariate Cox analysis identified patient age, site of the lesion, small mediastinal lymph nodes in CT imaging (SLNs in CT), dissected lymph nodes (LNs), and stage of esophageal malignancy as independent risk factors for OS of the patients. Of these factors, the site of the lesion, SLNs in CT and stage of the cancer were determined to be independent factors for DFS, RFS and LRFS. Based on all five factors, the recursive partitioning analysis (RPA) score system was developed to stratify the patients into low-, medium- and high-risk groups, which were found to possess significantly different rates of OS, DFS, RFS and LRFS (p < 0.001).

CONCLUSIONS

Several factors were associated with the survival of patients with pT_1-3 N₀M₀ ESCC who underwent extended esophagectomy with two-field lymphadenectomy. These factors contributed to the RPA scoring system, which could stratify the risk of postoperative survival and may expedite the initiation of postoperative adjuvant therapy.

Risk factors for tumor recurrence in patients with pT3N0M0 thoracic esophageal squamous cell carcinoma after esophagectomy

OBJECTIVE

To analyze the factors contributing to recurrence in patients with pT3N0M0 thoracic esophageal squamous cell carcinoma (ESCC).

METHODS

Patients with pT3N0M0 thoracic ESCC who underwent esophagectomy from January 2008 to December 2012 were included retrospectively. The last date of follow-up was 1 December 2016. Multivariate proportional hazard Cox models were used to identify factors associated with total (i.e., any) recurrence (TR), locoregional recurrence (LR), and distant metastasis (DM).

RESULTS

A total of 692 patients were included. The median follow-up was 53 months (range: 3-107). The 3- and 5-year TR, LR, and DM rates were 35.8% and 41.0%, 28.7% and 32.1%, and 16.8% and 21.1%, respectively. The Cox analyses showed that the tumor location, number of dissected lymph nodes, and postoperative therapies were significantly associated with LR. The subgroup analysis showed that postoperative therapies could significantly decrease LR in the mediastinum but not in the neck and upper abdomen regions.

CONCLUSIONS

The recurrence rate of pT3N0M0 thoracic ESCC patients was high, especially for LR in the mediastinum. Postoperative therapies can significantly reduce the incidence of mediastinal recurrence.

Comparison of Ivor Lewis and Sweet esophagectomy for middle and lower esophageal squamous cell carcinoma: A systematic review and pooled analysis

BACKGROUND

Lack of robust evidence highlights the important need to address the controversy on the clinical safety and effectiveness between Ivor Lewis versus Sweet procedure for middle and lower esophageal squamous cell carcinoma (ESCC).

METHODS

Search results were filtered according to certain criteria and were analyzed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

FINDINGS

The inter-study heterogeneity was high. Ivor Lewis procedure might be associated with longer operation time (p < 0.01) and higher lymph node yield (p < 0.01) compared with Sweet procedure. There was no significant difference in the length of hospital stay and postoperative complications with similar reoperation rate between the two procedures (p > 0.05). As the combined analysis of survival data revealed, there was no statistical difference in the oncologic efficacy of them (p = 0.97).

INTERPRETATION

The present study based on retrospective data with high heterogeneity indicated that Ivor Lewis esophagectomy might be associated with increased lymph node yield but longer operation time than Sweet. Prospective studies are warranted to compare the long-term survival of Ivor Lewis esophagectomy versus Sweet for middle and lower ESCC.