Prognostic Analysis Of T1b Esophageal Squamous Cell Carcinoma After Open And Minimally Invasive Esophagectomy

Objective: To analyze and compare the short-term and long-term effects of minimally invasive esophagectomy(MIE)and traditional open esophagectomy(OE)in patients with T1 b stage esophageal squamous cell carcinoma,and to provide a theoretical basis for the choice of surgical methods for patients with early esophageal cancer.Methods: This study collected the clinical and pathological data of patients who underwent thoracic surgery at Jiangsu Subei People’s Hospital from January 2015 to December 2018 and whose pathological diagnosis was T1 b stage esophageal squamous cell carcinoma.According to the surgical method,they were divided into minimally invasive esophagectomy group and open esophagectomy group.Inclusion criteria:ESCC was confirmed by gastroscopy and pathological biopsy before surgery;CT,color Doppler ultrasound,and PET-CT examinations were confirmed before surgery with no distant metastases such as lung,liver,and thoracic cavity.No neoadjuvant chemotherapy before surgery;all surgeries were performed by the same group of physicians,with minimally invasive or open Mckeown surgery;postoperative pathological diagnosis was ESCC at stage T1b;clinical and pathological data were complete and fully followed up.Exclusion criteria: cases converted to open thoracotomy during MIE;cases with other malignant tumors;cases with severe heart and lung dysfunction;cases that died of non-esophageal tumors during follow-up or lost follow-up;non-curative Resection(non-R0 resection)cases.The preoperative,intraoperative and postoperative data of the two groups of patients were observed and followed up.SPSS 25.0 was used for statistical analysis.The measurement data were tested using independent sample t test or Mann-Whitney U test;the classification data were tested using Pearson chi-square test,continuous correction test or Fisher exact probability method;Kaplan-Meier and Log-rank test compares the survival curves ofthe two groups and uses Cox proportional hazard regression models to analyze prognostic factors.Results: After screening,a total of 162 patients with T1 b stage ESCC were included in this study,there were 76 patients in the open esophagectomy group and 86 patients in the minimally invasive esophagectomy group.There was no statistically significant difference in general information such as gender,age,history of hypertension,history of diabetes,smoking history,drinking history,tumor location,etc.between the two groups.Compared with the OE group,the intraoperative bleeding volume of the MIE group(119.8 ± 70.0ml VS 210.5 ± 136.2ml,P <0.001)was less,and the number of lymph nodes dissected during the operation(19.1 ± 7.4 vs 13.8 ± 5.9,P <0.001)was more,postoperative pulmonary infections(9.3% VS 21.1%,P = 0.036)were less,but the operation time in the MIE group(240.0 ± 52.4min VS 179.5 ± 35.7min,P <0.001)was longer;There were no significant differences between the two groups in terms of postoperative hospital stay and anastomotic fistula,chylothorax,and secondary surgery.There were 162 patients in both groups,of which 21 patients had lymph node metastasis,and the lymph node metastasis rate was 13.0%.There were no significant differences in lymph node metastasis,vascular tumor thrombus,and tumor differentiation between the two groups.At the end of the follow-up,19 patients died,and the OS at 1 year,3 years,and 5 years after operation were 97.5%,88.8%,and 82.9%;31 patients had recurrence and metastasis,and the DFS at 1 year,3 years,and 5 years after operation were 95.1%,80.9%,and 75.6%.Log-rank test compared the OS and DFS survival curves between the MIE group and the OE group.There was no significant difference between the two groups.We perform a single factor analysis of survival data,the univariate analysis results of OS were: the drinking history,lymph node metastasis,pulmonary infection,anastomotic fistula,chylothorax and secondary surgery were related to OS in all patients(P <0.1).Including the above factors into the multivariate COX regression analysis results,we found that lymph node metastasis(HR = 6.025,P <0.001),anastomotic fistula(HR = 6.183,P = 0.003),and chylothorax(HR = 4.320,P = 0.038))were independent risk factors affecting OS in patients.The results of single factoranalysis of DFS were: lymph node metastasis,anastomotic fistula,chylothorax,vascular tumor thrombus,and drinking history were correlated with postoperative DFS(P <0.1).Including the above factors into the multivariate COX regression analysis results,we found that lymph nodes(HR = 3.589,P = 0.001),anastomotic fistula(HR = 3.318,P =0.003),chylothorax(HR = 3.555,P = 0.040),and vascular cancer thrombus(HR =3.834,P = 0.007)were independent risk factors affecting DFS in patients.Conclusion: MIE can achieve the same long-term effects as OE,with less intraoperative bleeding,greater number of lymph nodes dissected,and lower incidence of postoperative pulmonary infections,but it takes longer operation time.Lymph node metastasis,anastomotic fistula,and chylothorax are independent risk factors that affect the overall survival of patients with esophageal cancer.Lymph node metastasis,anastomotic fistula,chylothorax,and vascular cancer emboli are independent risk factors that affect disease-free survival in patients with esophageal cancer.