| Objective:The aim of our study was to compare the short-term and long-term outcomes between minimally invaisive Ivor-Lewis esophagectomy(MIILE)and minimally invasive Mckeown esophagectomy(MIME)for squamous cell carcinoma of middle and lower esophagus.Methods:The data of 268 consecutive patients who underwent minimally invasive surgery for middle and lower thoracic esophageal squamous cell carcinoma in the Department of Thoracic surgery of the first affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from August 2010 to March 2014 were retrospectively analyzed.They were divided into Minimally invasive Ivor-Lewis Esophagectomy(MIILE)group and Minimally Invasive Mc Keown Esophagectomy(MIME)group according to the mode of operation.Propensity Score Matching(PSM)method was used to balance the preoperative difference between the two groups.The operation time,the number of lymph node dissection and the incidence of postoperative complications were compared between the two groups.The postoperative recurrence and metastasis and the 1-,3-and 5-year survival rates were compared between the two groups.We were using t test,χ~2test,Kaplan-Meier curve and Log-rank test to compare preoperative data and overall survival of the two groups.Results:In this study,a total of 268 cases were followed up,a total of 249 cases were followed up,the success rate of follow-up was 92.9%,19 cases lost follow-up midway,and the rate of lost follow-up was 7.1%.After grouping with PSM,81 cases in MIILE group and 81 cases in MIME group were included in the study.There was no statistical difference in the baseline of case data between MIILE group and MIME group after PSM.MIILE group was superior to MIME group in operation time(238.8±51.2)min vs(262.4±41.5)min,anastomotic leakage rate 2.5%(2/81)vs 11.1(9/81),pulmonary infection incidence 6.2%(5/81)vs 16.0%(13/81)},and the difference was statistically significant(p<0.05).There was no significant difference between MIILE and MIME in the total number of lymph node dissection(19.5±5.4)vs(20.1±5.1)and thoracic lymph node dissection(11.9±3.9)vs(12.7±3.9).There was no significant difference between MIME group and MIILE group in the number of recurrent laryngeal nerve lymph node dissection.The 1-,3-and 5-year survival rates of the MIILE group were 87.7%,59.2%and 45.9%,respectively.The 1-,3-and 5-year survival rates of the MIILE group were 86.4%,58.7%and 42.8%,respectively.There was no significant difference in the 5-year survival rate between the two groups.Compared with MIME,MIILE had lower complication in pulmonary infection and anastomotic fistula,also had less operating time,whereas MIME had an advantage in the number of lymph nodes dissection adjacent to recurrent laryngeal nerve.The 1-year,3-year,5-year survival rate of MIILE were[87.7%,59.2%,45.9%],and the 1-year,3-year,5-year survival rate of MIME were[86.4%,58.7%,42.8%].There were no significant difference between two groups in 5-year survival rate.Conclusion:For middle and lower thoracic esophageal squamous cell carcinoma,there is no significant difference in long-term survival between MIILE and MIME.MIILE has an advantage over MIME in reducing operation time,pulmonary infection and anastomotic leakage in the short term,but MIME can remove more lymph nodes adjacent to the recurrent laryngeal nerve than MIILE,so MIME is recommended for patients with suspected enlarged lymph nodes adjacent to the recurrent laryngeal nerve. |
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