Comparative analysis on the modified Ivor-Lewis esophagectomy or Sweet esophagectomy plus postoperative chemoradiotherapy in the treatment of thoracic esophageal squamous cell carcinoma

PAN Xiaojie; GUO Tianxing; YE Mingfan; OU Debin

Abstract：Objective To retrospectively investigate the efficacy of modified Ivor?Lewis esophagectomy or Sweet esophagecto?my plus postoperative chemoradiotherapy in the treatment of thoracic esophageal squamous cell carcinoma and analyze the risk factors affecting the prognosis. Methods Ninety hundred and fourteen patients with thoracic esophageal squamous cell carcinoma were divided into modified Ivor?Lewis esophagectomy group( n=424) or Sweet esophagectomy group( n=490) . For the patients with stageⅡ and a?bove, they were divided into single operation group( n=297) and postoperative chemoradiotherapy group( n=446) . The patients were followed up and the survival time was calculated by Kaplan?Meier method. Difference in survival time was compared by Log?rank test. Cox regression analysis was performed to identify risk prognostic factors. Results The 1?, 3?, 5?year survival rates of modified Ivor?Lewis esophagectomy group and Sweet esophagectomy group were 86?3%, 63?7%, 44?5% and 90?2%, 64?9%, 45?0%, respectively. In stageⅡ and above patients, the median overall survival( OS) was 36?1 and 46?1 months in patients with single opera?tion and surgery plus postoperative chemoradiotherapy respectively( P=0?04) . The median OS was 34?6 and 46?8 months in patients with single operation and surgery plus postoperative chemoradiotherapy on modified Ivor?Lewis esophagectomy respectively, between which there was significant difference( P=0?038) . The median OS was 37?0 and 45?1 months in patients with single operation and sur?gery plus postoperative chemoradiotherapy on Sweet esophagectomy respectively, between which there was significant difference ( P=0?036) . The median OS were no statistical difference among the subgroups in the single operation group or surgery plus postoperative chemoradiotherapy group( P>0?05) . For the patients of stageⅡ,the median OS of surgery plus postoperative chemoradiotherapy group <br> was not higher than single operation group on modified Ivor?Lewis or Sweet esophagectomy( P>0?05) . For the patients with stage Ⅲ/Ⅳ, the median OS of surgery plus postoperative chemoradiotherapy group was higher than single operation group( P<0?05) . Cox pro?portional hazards model showed that age, histological differentiation, positive margin, depth of invasion, vascular cancer thrombus, positive lymph node, UICC stage and adjuvant radiation and chemotherapy postoperatively were prognostic factors for overall survival ( P<0?05) . Conclusion Both of modified Ivor?Lewis esophagectomy and Sweet esophagectomy are ideal operation method to treat tho?racic esophageal squamous cell carcinoma. Postoperative chemoradiotherapy could improve overall survival for patients with stage Ⅲand above.