Efficacy and safety of minimally invasive versus open esophagectomy following neoadjuvant immunochemotherapy in patients with locally advanced esophageal squamous cell carcinoma
ZHANG Yang
MA Wei
PAN Xi
SUN Chao
Abstract：Objective To compare the efficacy and safety of minimally invasive esophagectomy(MIE)versus open esophagectomy(OE)in patients with locally advanced esophageal squamous cell carcinoma(ESCC)following neoadjuvant immunochemotherapy(nICT).Methods A retrospective analysis was conducted on 164 ESCC patients who underwent surgery after nICT at Northern Jiangsu People's Hospital from January 2021 to January 2024.Patients were divided into the MIE group(n=75)and OE group(n=89).Perioperative parameters,nutritional-inflammatory indicators and survival data were compared between the two groups.Results Compared with the OE group,MIE group showed significantly less intraoperative blood loss,more right recurrent laryngeal nerve lymph nodes harvested,shorter postoperative hospital stay,lower 24-hour drainage volume,lower 24-hour pain scores,and lower incidence of postoperative complications(pulmonary infection,arrhythmia,and pleural effusion)(all P<0.05).OE group had shorter operation time(P<0.05).No signifi-cant differences were observed between MIE and OE groups in total lymph node yield,left recurrent laryngeal nerve lymph node dissection,R0 resection rate,incidence of postoperative complications(anastomotic leakage,anastomotic stenosis,respiratory insufficiency,chylothorax,hoarseness,wound infection,and reoperation,etc.),overall survival rate and dis-ease-free survival rate(all P>0.05).Postoperatively,both groups showed increased C-reactive protein/albumin ratio(CAR)and systemic immune-inflammation index(SII),and decreased prognostic nutritional index(PNI).OE group had higher CAR and SII,and lower PNI than MIE group(all P<0.05).Conclusions For locally advanced ESCC patients re-ceiving nICT,both MIE and OE can achieve satisfactory therapeutic effect.However,MIE demonstrates superior advan-tages in perioperative safety,control of systemic stress response and enhanced recovery.
Keywords：minimally invasive esophagectomyopen esophagectomyneoadjuvant immunochemotherapyesopha-geal squamous cell carcinoma
Publication Date：2025-04-25
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 83-87 )