SCI

16 April 2024

Recurrence and Survival after Minimally Invasive and Open Esophagectomy for Esophageal Cancer - A Post Hoc Analysis of the Ensure Study

（Annals of Surgery; if=10.1）

  • Henckens SP, Schuring N, Elliott JA, Johar A, Markar SR, Gantxegi A, Lagergren P, Hanna GB, Pera M, Reynolds JV, van Berge Henegouwen MI, Gisbertz SS; ENSURE study group

  • Correspondence: s.s.gisbertz@amsterdamumc.nl 

Objective 目的

The aim of this study was to determine the impact of operative approach (open [OE], hybrid [HMIE] and total minimally invasive esophagectomy [TMIE]) on operative and oncologic outcomes for patients treated with curative intent for esophageal and junctional cancer. 

本研究旨在研究手术入路（开放式[OE]、混合式[HMIE]和全微创食管切除术[TMIE]）治疗食管癌和交界癌患者的手术和肿瘤结果的影响。

 

Summary background data 背景

The optimum oncologic surgical approach to esophageal and junctional cancer is unclear.

食管癌和交界癌的最佳肿瘤手术方法尚不明确。

 

Methods 方法

This secondary analysis of the European multicenter ENSURE study includes patients undergoing curative-intent esophagectomy for cancer between 2009-2015 across 20 high-volume centers. Primary endpoints were disease-free survival (DFS) and the incidence and location of disease recurrence. Secondary endpoints included among others R0 resection rate, lymph node yield and overall survival (OS).

这项欧洲多中心 ENSURE 研究的二次分析包括 2009-2015 年间在 20 个大型中心接受治愈性食管癌切除术的患者。主要终点是无病生存期（DFS）以及疾病复发的发生率和部位。次要终点包括R0切除率、淋巴结切除率和总生存率（OS）。

 

Results 结果

In total, 3,199 patients were included. Of these, 55% underwent OE, 17% HMIE and 29% TMIE. DFS was independently increased post TMIE (HR 0.86 [95% CI 0.76-0.98], P=0.022) compared with OE. Multivariable regression demonstrated no difference in absolute locoregional recurrence risk according to operative approach (HMIE vs. OE OR 0.79, P=0.257, TMIE vs. OE OR 0.84, P=0.243). The probability of systemic recurrence was independently increased post HMIE (OR 2.07, P=0.031), but not TMIE (OR 0.86, P=0.508). R0 resection rates (P=0.005) and nodal yield (P<0.001) were independently increased after TMIE, but not HMIE (P=0.424; P=0.512) compared with OE. OS was independently improved following both HMIE (HR 0.79, P=0.009) and TMIE (HR 0.82, P=0.003) as compared with OE.

共纳入了 3199 名患者。其中，55%接受了OE，17%接受了HMIE，29%接受了TMIE。与OE相比，TMIE后的DFS增加（HR 0.86 [95% CI 0.76-0.98]，P=0.022）。多变量回归显示，不同手术方式的局部复发绝对风险没有差异（HMIE vs. OE OR 0.79，P=0.257；TMIE vs. OE OR 0.84，P=0.243）。HMIE术后全身复发的概率会独立增加（OR 2.07，P=0.031），但TMIE术后不会（OR 0.86，P=0.508）。TMIE R0切除率（P=0.005）和结节率（P<0.001）独立增加，但HMIE（P=0.424；P=0.512）与OE相比没有增加。与 OE 相比，HMIE（HR 0.79，P=0.009）和 TMIE（HR 0.82，P=0.003）均可独立改善 OS。

 

Conclusion 结论

In this European multicenter study, TMIE was associated with improved surgical quality and DFS, while both TMIE and HMIE were associated with improved OS as compared with OE for esophageal cancer.

在这项欧洲多中心研究中，TMIE 与手术质量和 DFS 的改善相关，而与 OE 相比，TMIE 和 HMIE 与食管癌 OS 的改善相关。

 

 

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