| Object:(1)To explore the safety of minimally invasive esophagectomy(MIE)with three-field lymphadenectomy(3-FL)(neck,thorax,abdomen)for esophageal squamous cell carcinoma(ESCC)by comparing the short-term outcomes between the 3-FL group and the two-field lymphadenectomy(2-FL)(thorax,abdomen)group in MIE.(2)To analyze the risk factors of cervical lymph node metastasis(CLNM)in patients with ESCC,develop a risk prediction model and map it into a nomogram to help clinicians screen patients at high risk of CLNM.Methods:(1)The clinical data of 257 patients with ESCC who underwent MIE were retrospectively analyzed,including 109 patients in 3-FL group and 148 patients in 2-FL.The surgical results and postoperative complications of the two groups were compared(P<0.05 was considered statistically significant).(2)The clinical data of 127 patients with ESCC who underwent radical esophagectomy with 3-FL were retrospectively collected.Logistic regression analysis was used to screen the risk factors of CLNM of ESCC(P<0.2 was considered statistically significant),and a rick prediction model was established and a nomogram was drawn by R software.Result:(1)The operation time in the 3-FL group increased by an average of 20 minutes compared to the 2-FLgroup(247.4±47.0min vs 225.7±46.5min,P<0.001).But,the intraoperative blood loss between the two groups was no significant difference(177.8 ± 99.1ml vs.168.3±63.1ml,P=0.376).More lymph nodes[49.0(24)vs 29.5(13),P<0.001]and also more positive lymph nodes[1(4)vs 0(3),P=0.003]were obtained in the 3-FL group than in the 2-FL group,and there was a statistical difference in the pathological N stage between the two groups(P<0.001).But there was no significant difference in the incidence of anastomotic leak,chyle leak,recurrent laryngeal nerve injury,pulmonary complications,pneumonia,cardiac complications and overall complications between the two groups(P<0.05).And there was also no significant difference in the Clavien-Dindo Grading System(P=0.062).(2)The univariate analysis showed that the distance between the tumor starting site and the incisors,tumor size,differentiation degree,vascular invasion,recurrent laryngeal nerve lymph nodes(RLN LNs)metastasis and age were related factors affecting CLNM for ESCC.The results of Multivariate logistic regression analysis showed that the distance between the tumor starting site and the incisors(P=0.062),RLN LNs metastasis(P=0.040)and age(P=0.197)were independent risk factors affecting CLNM of ESCC.According to the results of multivariate logistic regression,the risk prediction model was established:Y=ez/(1-ez),z=-17.106-0.087 ×X1+0.097 × X2-0.063× X3(X1=the distance between the tumor starting site and the incisors(cm);X2=0 indicated no RLN LNs metastasis,X2=1 indicated RLN LNs metastasis;X3=age(years)).Hosmer-Lemeshow(H-L)test was used to detect the fitting degree of the model(P=0.293).the discrimination of the model was detected by the receiver operating characteristic curve(the ROC curve),with the area under curve(AUC)as 0.715(95%confidence interval:0.618～0.811).The prediction model equation was consistent with the actual observation results.Conclusions:(1)3-FL MIE can improve the efficiency of lymph node dissection and the accuracy of tumor lymph node staging,and it does not increase the postoperative complications,which is worthy of clinical application.(2)The distance between the tumor starting site and the incisors,RLN LNs metastasis and age were independent risk factors affecting CLNM of ESCC.Establishing a risk prediction model and drawing a nomogram can effectively screen high-risk patients with CLNM and formulate an individualized and accurate treatment plan for them. |
