Efficacy Analysis Of Total Mesoesophageal Excision By Thoracoscopy And Laparoscopy Based On Propensity Score Matching

Objective: To investigate the safety and oncologic efficacy of thoracoscopic and laparoscopic total mesoesophageal excision for esophageal cancer.Methods: We retrospectively collected data of patients with esophageal cancer who were treated by the same surgical team in the Department of Thoracic Surgery of our hospital from January 2011 to June 2017.611 patients were included in the study,of which 302 patients underwent thoracoscopic and laparoscopic total mesoesophageal excision(TME group),309 patients underwent esophagectomy by thoracoscopy and laparoscopy with non-total mesoesophageal excision(NME group).A 1: 1 matching was performed by the propensity score matching method,and p T1-2 and p T3-4a patients were selected from all the included patients for subgroup analysis.The baseline and clinical characteristics,intraoperative conditions,postoperative complications,recurrence,and survival of the two groups of patients were compared to comprehensively evaluate the clinical efficacy of minimally invasive total mesoesophageal esophagectomy.Results: There were statistically significant differences in lymph node metastasis,TNM stage,and lymph node dissection between the two groups before matching.After matching,249 pairs were successfully matched.There were no significant differences in baseline and clinical characteristics between the two groups after matching.In the subgroups,91 pairs of p T1-2 patients were successfully paired,and 128 pairs of p T3-4a patients were successfully paired.TME group had shorter operative time(P < 0.001),less intraoperative bleeding(P < 0.001),and shorter postoperative hospital stay(P <0.001).There were no significant differences in the number of removed lymph nodes,30-day mortality,and the incidence of postoperative complications in the two groups.The 2-year OS rate in the TME group was 81.2%,compared with 77.0% in the NME group,and the difference was not statistically significant(P = 0.212).The 2-year DFS rate in the TME group was 74.0%,compared with 70.9% in the NME group,and the difference was not statistically significant(P = 0.334).The 2-year recurrence rate in the esophageal bed area of the TME group was significantly lower than that of the NME group(TME group vs.NME group,0.4% vs.3.6%,P = 0.011).Among patients with p T3-4a,the 2-year OS rate in the TME group was 75.2%,and the NME group was64.0%.The difference was statistically significant(P = 0.039).The 2-year DFS rate in the TME group was 68.3%,and it was 57.3% in the NME group,the difference was statistically significant(P = 0.040);the recurrence rate of esophageal bed area in TME group was also significantly lower than that in NME group(TME group vs.NME group,0% vs.7.0%,P = 0.003).Among patients with stage p T1-2,there were no significant differences in OS,DFS,total recurrence rate,and recurrence in various parts of the two groups.Conclusion: Thoracoscopic and laparoscopic total mesoesophageal excision could reduce tumor recurrence in the local esophageal bed area after esophageal squamous cell carcinoma.Especially in patients with tumor infiltration of p T3-4a,the surgical removal of the lesion ws more thorough,at the same time it had both safety and minimally invasive features,and brought survival benefits to patients after surgery.For patients with tumor infiltration of p T1-2,the long-term benefit of this procedure remained to be seen.