| OBJECTIVES:To compare the short-term and long-term curative effects and prognosis of pT3 and pT4a esophageal squamous cell carcinoma after open and minimally invasive McKeown surgery respectively,and to explore a more suitable treatment scheme for middle and advanced esophageal squamous cell carcinoma from the comparison results,and to screen out the indicators that have an impact on survival and prognosis by statistical methods.METHODS:The clinical data of 216 cases of pT3 and pT4a esophageal squamous cell carcinoma(ESCC)in our hospital from January 2017 to March 2018 were analyzed retrospectively.Patients were divided into two groups:minimally invasive surgery(MIE)and open surgery(OE).112 patients underwent minimally invasive surgery and 104 patients underwent open surgery.Patients with regional lymph node stage N2 were treated with neoadjuvant therapy,including 15 patients in the open group and 21 patients in the minimally invasive group.The general data,intraoperative data,complications and recurrence related data of patients were counted.SPSS 22.0 was used for statistical analysis.Calculate the mean,median and standard deviation of continuous variables.T test,chi-square test,continuous correction test and Fisher’s exact test were used to compare the classified variables between the two groups.Univariate analysis was carried out on the classified variables that may be related to the survival prognosis,such as operation mode,age,sex,BMI,smoking history,drinking history,hypertension history,diabetes history,tumor location,lung infection,chylothorax,second operation,anastomotic leakage,lymph node metastasis,tumor differentiation degree,vascular tumor thrombus,etc.,and the factors that have an impact on the overall survival rate and disease-free survival rate respectively(P<0.05 Finally,independent risk factors affecting the overall survival rate and disease-free survival rate were screened out by multivariate analysis.P<0.05 is considered statistically significant.Kaplan-Meier method was used to calculate the overall survival curve and recurrence-free survival curve,and logrank test was used to compare them.The survival curve was drawn by GraphPad9.3.0 software.KPS(Karnofshy Performance Scale)is a tool for evaluating dysfunction,and its ranking ranges from 100 to 0,with a score of every 10 points.Where 100 stands for"perfect" health and 0 stands for death;The higher the score,the better the patient’s health.Quality of life was measured by the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire(EORTC QLQ-C30)and Esophageal Cancer Supplementary Scale(OES-18).The QLQ-C30 questionnaire includes the overall health and quality of life scale,four functional scales(body,role,cognition and society),three symptom scales(fatigue,pain,nausea and vomiting)and seven single symptom scales(insomnia,dyspnea,constipation,diarrhea,loss of appetite,economic difficulties and speech difficulties).QLQ-OES18 includes four symptom scales(dysphagia,dysphagia,gastroesophageal reflux and pain)and six single symptom scales(swallowing,choking,dry mouth,dysphagia,cough and dysphasia).The original scores of EORTC QLQ-C30 and QLQ-OES18 are converted according to standard methods.For functional scale,the higher the score,the better the function,while for symptom and single scale,the higher the score,the more serious or more symptoms.Quality of life assessment scale(KPS)was used to evaluate the patients’ quality of life one week before operation and one,three and six months after operation,and European Organization for Research and Treatment questionnaire QLQC-30(EORTC QLQC-30)and Esophageal Cancer Supplementary Scale(QLQ-OES18)were used to evaluate the patients’ quality of life one week before operation and one month after operation.RESULT:(1)The operation time in MIE group was longer than that in OE group(266.92 ± 29.753 min vs.179.78 ± 27.25 min,P<0.01).However,the MIE group has obvious advantages in the amount of bleeding(90.63 ± 55.154 ml vs.265.87±86.53 ml,P<0.01)and lymph node dissection(19.72±6.13 vs.14.18±5.619,P<0.01).(2)The 1-year,3-year and 5-year overall survival rates of all patients were 81.48%,60.49%and 35.29%respectively.For patients in OE group,the overall survival rates of 1 year,3 years and 5 years were 82.69%,57.69%and 30.32%,respectively.For patients in MIE group,the overall survival rates of 1 year,3 years and 5 years were 80.36%,63.17%and 39.79%respectively.Log-rank test showed that there was no significant difference in the overall survival rate between the two groups(χ2=1.272,P=0.259).(3)The 1-year,3-year and 5-year recurrence-free survival rates of all patients were 81.48%,60.49%and 35.29%respectively.For patients in OE group,the overall survival rates of 1 year,3 years and 5 years were 82.69%,57.69%and 30.32%,respectively.For patients in MIE group,the overall survival rates of 1 year,3 years and 5 years were 80.36%,63.17%and 39.79%respectively.Log-rank test showed that there was no significant difference in the overall survival rate between the two groups(χ2=1.272,P=0.259).The 1-year,3-year and 5-year recurrence-free survival rates of all patients were 77.78%,47.12%and 26.05%respectively.For patients in OE group,the 1-year,3-year and 5-year recurrence-free survival rates were 79.81%,44.23%and 22.45%respectively.For patients in MIE group,the 1-year,3-year and 5-year recurrence-free survival rates were 75.89%,49.79%and 29.29%respectively.Log-rank test showed that there was no significant difference in prognosis and recurrence-free survival between the two groups(χ2=1.111,P=0.292).(4)The results of multivariate analysis showed that chylothorax,anastomotic leakage and lymphatic metastasis were independent risk factors to determine the overall survival rate and disease-free survival rate.(5)Comparison of KPS scores between the two groups:There was no significant difference in KPS scores between the two groups one week before operation(90 vs.90,P=0.768);At 1 month,3 months and 6 months after operation,the KPS score of MIE group was higher than that of OE group,and the differences were statistically significant(P<0.05).(6)Comparison of QLQ-C30 scores between the two groups:One week before operation,there was no significant difference in QLQ-C30 scores between the two groups(P>0.05).One month after operation,the scores of overall health status,physical function,role function and social function in MIE group were higher than those in OE group,and the differences were statistically significant(P<0.05).The scores of fatigue,nausea and vomiting,pain,dyspnea,loss of appetite and constipation in MIE group were lower than those in OE group,and the differences were statistically significant(P<0.05),while the other indexes(cognitive function,insomnia,diarrhea,economic difficulties and speech difficulties)were not statistically significant(P>0.05).(7)Comparison of QLQOES18 scores between the two groups:One week before operation,there was no significant difference in QLQ-OES18 scores between the two groups(P>0.05).One month after operation,the scores of eating difficulty,gastroesophageal reflux,pain,choking sensation,abnormal taste and cough difficulty in MIE group were lower than those in OE group,and the differences were statistically significant(P<0.05),while the other indexes(dysphagia,swallowing,dry mouth and dysphasia)were not statistically significant(P>0.05).Conclusion:Compared with open(OE)surgery,minimally invasive(MIE)surgery can also achieve the same perioperative results and prognosis in the treatment of pT3 and pT4a esophageal squamous cell carcinoma,and the intraoperative blood loss and lymph node dissection gauge of minimally invasive(MIE)surgery are obviously superior,and the postoperative quality of life of minimally invasive group is better than that of open group.The disadvantage is that the operation time of MIE group is relatively longer. |
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