Abstract
Background
The effects of minimally invasive total mesoesophageal excision (MITME) on the long-term prognosis of locally advanced esophageal squamous cell carcinoma (ESCC) remain unknown. The objective of this study was to compare the static and dynamic failure patterns of MITME and minimally invasive esophagectomy (MIE) for locally advanced ESCC.
Methods
We use propensity score matching (PSM) method to analyze the postoperative failure patterns of the two groups. Cumulative event curves were analyzed for cumulative incidence of failure between different groups, and independent prognostic factors were assessed using time-dependent multivariate analyses. The risk of dynamic failure calculated at 12-month intervals was compared between the two groups using the lifetime table.
Results
A total of 366 ESCC patients were studied by 1:1 PSM for T stage and TNM stage (MITME group, n = 183; MIE group, n = 183). In the matched cohort, there was significant differences between the MITME and MIE groups in the failure pattern of regional lymph node recurrence (0.5 vs 3.8%, P = 0.032) and non-tumor death (10.9 vs 31.7%, P < 0.001). The cumulative event curve found that the 5-year cumulative failure rate was lower in the MITME group than in the MIE group (3.3 vs 17.1%, P = 0.026) after 5 years of survival. In addition, multivariate Cox regression analysis showed that MIE was an independent poor prognostic factor for a high cumulative failure rate in locally advanced ESCC patients at 5 years after surgery (HR:4.110; 95% CI 1.047–16.135; P = 0.043). The dynamic risk curve showed that the MITME group had a lower risk of failure within 5 years after surgery than the MIE group.
Conclusion
Considering that MITME can significantly improve the postoperative failure pattern and the benefit lasts for at least 5 years, it is feasible to use MITME as a treatment for locally advanced ESCC.
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Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
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Acknowledgements
The authors thank all the medical staff who contributed to the maintenance of the medical record database.
Funding
This study was supported by grants from the Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University (No. 0713304); the Natural Science Foundation in Fujian Province (No. 2020J011004); the Fujian provincial health technology project (No. 2020CXA028); the cohort study of the School of Public Health, Fujian Medical University (No. 2021HX003); the Joint Funds for the innovation of science and Technology, Fujian province (No. 2020Y9076); and the National Nature Science Foundation of China (No. 82273415).
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Conception/Design: SCC, JHL and SJX. Collection and/or assembly of data: JHL, SJX, CC, CXY, RQC, ZFZ and SCC. Data analysis and interpretation: JHL, SJX, CXY, CC, ZFZ, RQC, and SCC. Manuscript writing: JHL, SJX, and SCC. All authors have read and approved the final manuscript.
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Ji-hong Lin, Shao-jun Xu, Chao Chen, Cheng-xiong You, Rui-qin Chen, Zhi-fang Zhang, and Shu-chen Chen have no conflicts of interest or financial ties to disclose.
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464_2023_10334_MOESM1_ESM.tif
Supplementary file1 (TIF 7340 KB) Fig. S1 Mesoesophagus of upper esophagus (A), mesoesophagus of middle esophagus (B), mesoesophagus of lower esophagus (C) in surgical field, esophagus from the total mesoesophageal excision (D)
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Lin, Jh., Xu, Sj., Chen, C. et al. Impact of minimally invasive total mesoesophageal excision and minimally invasive esophagectomy on failure patterns of locally advanced esophageal squamous cell carcinoma: a matched cohort study with long-term follow-up. Surg Endosc 37, 7698–7708 (2023). https://doi.org/10.1007/s00464-023-10334-0
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DOI: https://doi.org/10.1007/s00464-023-10334-0