[Analysis of the effect of inflatable mediastinoscopy esophagectomy and minimally invasive Mckeown esophagectomy combined with thoracoscopy and laparoscopy in the treatment of early esophageal cancer]

Objective: To explore the operioperative and long-term outcomes of inflatable mediastinoscopic resection of esophageal carcinoma (IVMTE) and minimally invasive Mckeown resection of esophageal carcinoma (MIME) in early esophageal cancer. Methods: This is a retrospective cohort study. A retrospectively analysis was conducted on 176 patients with cT1N0M0 esophageal cancer who underwent IVMTE or MIME at the Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated with Anhui Medical University from April 2017 to April 2019. There were 128 males and 48 females, aged (66.4±7.7) years (range: 45 to 87 years). General data, perioperative outcomes, pathological data of the tumors, and complications were recorded. Independent sample t-test, χ² test, and Wilcoxon rank-sum test was used to compare the data between the two groups. Propensity score matching was performed with gender, age, tumor location, differentiation degree, pT stage, pN stage, American Society of Anesthesiologists (ASA) classification, smoking history, and alcohol history were considered as covariates. The IVMTE group and MIME group were matched in a 1∶2 ratio using nearest neighbor match method with a caliper value of 0.02. Kaplan-Meier method was used to plot survival curves, with Log-rank test for univariate survival analysis. The Cox proportional hazards model was applied to analyze prognostic factors for overall survival, and subgroup stratification analysis was performed for pT stage. Results: After matching, the MIME group consisted of 54 cases, and the IVMTE group consisted of 27 cases. There were no statistically significant differences between the two groups in terms of gender, age, smoking history, alcohol history, ASA classification, tumor location, and other factors. The IVMTE group had shorter surgery time (M(IQR), 220 (45) minutes vs. 245 (56) minutes, Z=2.950, P=0.003) and less intraoperative blood loss (100 (50) ml vs. 125 (100) ml, Z=2.193, P=0.028) compared to the MIME group. There were no differences between the two groups in the number and quantity of lymph node stations dissected, and the IVMTE group was not at a disadvantage in terms of the number of lymph nodes dissected around the recurrent laryngeal nerve (all P>0.05). The 1-, 3-, and 5-year overall survival (OS) rates and recurrence-free survival (RFS) rates were not significantly different between the two groups (all P>0.05). Subgroup analysis showed no significant difference in OS and RFS rates between the pT1 and pT2 subgroups (all P>0.05). Multivariate Cox regression analysis suggested that ASA classification (HR=2.516, 95%CI: 1.126 to 5.624, P=0.025), pN stage (HR=2.485, 95%CI: 0.984 to 6.274, P=0.046), and whether adjuvant therapy was given postoperatively (HR=2.915, 95%CI: 1.304 to 6.515, P=0.009) were independent risk factors affecting 5-year OS rate. For 5-year RFS, pT stage (HR=0.403, 95%CI: 0.194 to 0.838, P=0.011), pN stage (HR=5.219, 95%CI: 2.401 to 11.346, P<0.01), and whether adjuvant therapy was given postoperatively (HR=5.644, 95%CI: 2.691 to 11.838, P<0.01) were independent risk factors, while the surgical approach was not an independent risk factor affecting patient prognosis. Conclusion: The short-term and long-term effect of IVMTE in the treatment of early esophageal cancer is good, and it can achieve effects comparable to MIME.