Five-year Survival after McKeown Compared to Ivor-Lewis Esophagectomy for Esophageal Cancer

医学 食管切除术 危险系数 食管癌 淋巴结切除术 食管 人口 存活率 癌症 外科 普通外科 内科学 置信区间 环境卫生
作者
Anna Junttila,Olli Helminen,Mika Helmiö,Heikki Huhta,Raija Kallio,Vesa Koivukangas,Arto Kokkola,Seppo Laine,Elina Lietzén,Sanna Meriläinen,Vesa-Matti Pohjanen,Tuomo Rantanen,Ari Ristimäki,Jari Räsänen,Juha Saarnio,Eero Sihvo,Vesa Toikkanen,Tuula Tyrväinen,Antti Valtola,Joonas H Kauppila
出处
期刊:Annals of Surgery [Lippincott Williams & Wilkins]
卷期号:277 (6): 964-970 被引量:4
标识
DOI:10.1097/sla.0000000000005437
摘要

The aim of study was to compare overall 5-year survival of esophageal cancer patients undergoing transthoracic esophagectomy with either neck or intrathoracic anastomosis, that is, McKeown and Ivor-Lewis esophagectomy.No national studies comparing long-term survival after McKeown and ivor-Lewis esophagectomies in the West exist.This population-based nationwide study included all curatively intended transthoracic esophagectomies for esophageal adenocarcinoma or squamous cell carcinoma in Finland in 1987 to 2016, with follow-up until December 31, 2019. Cox proportional hazard models provided hazard ratios (HR) with 95% confidence intervals (ci) of all-cause 5-year mortality. The results were adjusted for age, sex, year of the operation, comorbidities, histology, stage, and neoadjuvant treatment. Adjusted model 2 included also tumor location and lymph node yield.A total of 990 patients underwent McKeown (n = 278) or Ivor-Lewis (n = 712) esophagectomy The observed overall 5-year survival was 43.1% after McKeown, and 45.9% after Ivor-Lewis esophagectomy. McKeown esophagectomy was not associated with the overall 5-year mortality (adjusted HR 1.11, 95% CI: 0.89-1.38), compared to Ivor-Lewis esophagectomy. Additional adjustment for tumor location and lymphadenectomy further attenuated the point estimate (HR 1.06, 95% CI: 0.85-1.33). Surgical approach was not associated with 90-day mortality rate (adjusted HR 1.15, 95% CI: 0.67-1.97).This population-based nationwide study suggests that overall 5-year survival or 90-day survival with McKeown and Ivor-Lewis esopha-gectomy for esophageal cancer are comparable.
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