| Objective:By comparing the effect of upper mediastinal lymph nodes in the thoracoscopic laparoscopic esophagectomy(TLE)and open surgery(McKeown or Ivor-Lewis),which provides theoretical guidance for the selection of surgical methods for esophageal cancer.Methods:This study used a retrospective cohort study to analyze 249cases of esophageal squamous cell carcinoma who underwent TLE,McKeown or Ivor-lewis surgery in the Department of Thoracic Surgery,Fourth Hospital of Hebei Medical University from January 2016 to January 2019.To compare the difference in the number of lymph node dissection,lymph node metastasis rate,lymph node metastasis degree,and lymph node dissection rate between the TLE group and the Open group.Results:1.A total of 249 patients with esophageal cancer were included,including 204 in the TLE group and 45 in the Open group.There were no significant difference in gender and age between the two groups(P>0.05).2.The rates of upper mediastinal,middle mediastinal,lower mediastinal and abdominal lymph node metastasis in the TLE group were 38.7%(79/204),17.6%(36/204),11.8%(24/204),and 20.6%(42/204),with statistically significant differences(?~2=47.9,P<0.001),and in the Open group were 55.6%(25/45),33.3%(13/45),17.8%(8/45),and 42.2%(19/45),with statistically significant differences(?~2=14.53,P=0.002).And there was significant difference in the upper mediastinal lymph node metastasis rate between TLE group and Open group(?~2=4.29,P=0.038).3.The rates of upper mediastinal,middle mediastinal,lower mediastinal and abdominal lymph node metastasis in patients with upper thoracic esophageal cancer were 45.9%(17/37),5.4%(2/37),2.7%(1/37)and 2.7%(1/37),respectively,with statistically significant differences(?~2=41.0,P<0.001).And in patients with middle thoracic esophageal cancer were41.4%(53/128),21.1%(27/128),10.9%(14/128)and 23.4%(30/128),respectively,with statistically significant differences(?~2=33.6,P<0.001).And in patients with lower thoracic esophageal cancer were 40.5%(34/84),26.2%(22/84),20.2%(17/84)and 35.7%(30/84),respectively,with statistically significant differences(?~2=9.9,P=0.02).And the rates of upper mediastinal lymph node metastasis in the upper,middle and lower thoracic segments were no statistically significant(?~2=0.3,P=0.85).4.The average total number of lymph nodes dissected in TLE group and Open group was 23.86±8.92 and 22.18±8.38,respectively,with no statistically significant difference(t=1.16,P=0.247).The average number of lymph nodes dissected in the upper mediastinum of TLE group and Open group was8.63±4.51 and 6.96±4.90,respectively,and the difference was statistically significant(t=2.22,P=0.027).For the Group 2L,the average number of lymph nodes dissected was 3.37±3.03 and 2.09±2.08 respectively in TLE group and Open group,and the difference was statistically significant(t=2.71,P=0.007).The average number of lymph nodes dissected in the other groups of the upper mediastinum showed no statistically significant difference between the two groups(P>0.05).5.The lymph node dissection rates of Group 2L in TLE group and Open group were 89.7%(183/204)and 71.1%(32/45),respectively,with statistically significant difference(?~2=10.81,P=0.001).The lymph node dissection rates in the Group 4L were 41.2%(84/204)and 22.2%(10/45),respectively,with statistically significant difference(?~2=5.64,P=0.02).The lymph node dissection rates of the other groups in the upper mediastinum showed no statistically significant difference between the two groups(P>0.05).6.The upper mediastinal lymph node metastasis degree in the TLE group and Open group were 8.8%(155/1761)and 23.0%(72/313),with statistically significant difference(?~2=54.99,P<0.001).Conclusions:1.The metastasis rate of the upper mediastinal lymph node in the thoracic esophageal cancer was significantly higher than that of other regions,and did not decrease with the descending of tumor location.2.For the effect of upper mediastinal lymph node dissection in the thoracic esophageal cancer,TLE is significantly superior to open surgery,especially in the Group 2L and the Group 4L. |
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