Comparative analysis of manual vs. mechanical suturing techniques in esophagectomy: A propensity score‑matched study of long‑term outcomes
- Authors:
- Published online on: November 11, 2024 https://doi.org/10.3892/ol.2024.14797
- Article Number: 51
-
Copyright: © Lu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Abstract
Introduction
Esophageal cancer is recognized as one of the most aggressive types of malignancy, with a poor prognosis and low overall survival rate, making it a significant global health concern. The main histological type of this cancer, particularly common in East Asian populations, is esophageal squamous cell carcinoma (ESCC) (1–3). Patients with ESCC still have high risks of lymph node (LN) metastasis and poor long-term overall survival (OS) outcomes (4–6). Depending on the clinical stage, patients often undergo preoperative neoadjuvant chemotherapy, chemoradiotherapy or chemotherapy immunization, followed by postoperative immunotherapy maintenance. Despite advancements in treatment strategies, esophagectomy remains the primary treatment approach for ESCC within multimodal therapy (7–10).
Surgical outcomes in esophagectomy are influenced by various patient-specific factors, underscoring the necessity for personalized treatment approaches tailored to individual clinical scenarios (11–13). While manual suturing (MS) has traditionally been the method of choice (14–16), the emergence of mechanical suturing (MeS) as a viable alternative has garnered interest (17,18). MS, also known as hand-sewn anastomosis, is a traditional surgical technique used to join the two ends of the esophagus following resection. This method provides greater flexibility in tailoring the anastomosis to the specific anatomical and physiological conditions of the patient; however, it is typically more time-consuming. By contrast, MeS, or stapled anastomosis, is a more modern technique that employs a mechanical stapler to connect the esophageal tissues. This approach creates a secure and uniform anastomosis, ensuring consistency in tissue approximation while reducing operative time. Additionally, the use of a stapler requires specific equipment and may incur higher costs compared to manual suturing. MeS was first reported by Sugimura et al (15), and later improved by Orringer et al (19). Both MS and MeS techniques have their specific advantages and disadvantages. Studies by Kondra et al (20), Singhal et al (21) and Singh et al (22) suggest that MeS significantly reduces the incidence of postoperative anastomotic leaks and strictures in esophageal cancer surgeries, considering it a safe and effective technique. When MeS is difficult or fails, MS becomes an important alternative (23). Initial comparisons between MS and MeS have indicated similar immediate postoperative outcomes and complication rates, hinting at a potential shift in surgical techniques (24). However, controversy remains over which suturing method is better and long-term survival data comparing these techniques in esophagectomy are lacking. Such research is essential for refining surgical practices and enhancing the long-term prognosis of patients undergoing esophagectomy for ESCC.
The present study aimed to account for various potential confounders in order to ensure an unbiased and precise comparison of the long-term outcomes linked to each technique. This will be achieved through a comprehensive causal inference analysis to compare the long-term outcomes of MS and MeS following esophagectomy.
Materials and methods
Patients and methods
This retrospective study examined data from 2,510 patients diagnosed with ESCC who underwent esophagectomy at Sichuan Cancer Hospital (Sichuan, China) between January 2010 and December 2017. The data were obtained from the Esophageal Cancer Case Management database of Sichuan Cancer Hospital and Institute. The study aimed to compare the long-term OS outcomes between MS and MeS techniques used in esophagectomy. Patients included in the study had undergone esophagectomy for ESCC within the specified period and met the criteria of thoracic ESCC staging according to the 8th edition TNM staging system by the Union for International Cancer Control/American Joint Committee on Cancer (25). Exclusion criteria encompassed non-squamous cell carcinoma histology in a surgical specimen, tumors located outside the thoracic esophagus, evidence of distant metastasis, R1/R2 resection (indicative of incomplete tumor removal), stage pTis/T1a, receipt of preoperative neoadjuvant therapy and missing data (Fig. 1).
Outcome measures
Demographic data, smoking and alcohol consumption history, clinical stage and tumor characteristics were collected for each patient. Clinical staging was reviewed by multiple experts and pathological findings were confirmed by two pathologists, with a third pathologist's review for accuracy. Patients were followed up every 3 months for the first 2 years post-surgery and then every 6 months for the next 3–5 years. OS, defined as the time from surgery to death from any cause or last known follow-up, served as the primary endpoint.
Statistical analysis
Categorical variables were presented as percentages and analyzed using chi-square or Fisher's exact test, as appropriate. The Kaplan-Meier method was used to generate survival curves and differences were assessed using the log-rank test. Univariate and multivariate logistic regression using the Cox proportional hazards model identified independent predictors of OS, providing hazard ratios (HRs) and 95% confidence intervals (CIs). To minimize selection bias and balance baseline characteristics between the MS and MeS Groups, four causal inference methods was performed. Propensity scores were calculated using logistic regression based on age, sex and other relevant baseline characteristics [propensity score matching (PSM)]. A 1:1 nearest-neighbor matching algorithm without replacement and a caliper width of 0.25 times the standard deviation of the logit of the propensity score were used. Sensitivity analyses with inverse probability of treatment weighting (IPTW), overlap weighting (OW) and standardized mortality ratio weighting (SMRW) validated the findings. Statistical significance was set at a two-sided P-value of <0.05. Analyses were conducted using SPSS version 23.0 (IBM Corp.) and RStudio software with R 4.3 (The R Foundation).
Results
Demographic data
The initial dataset included 2,957 patients diagnosed with ESCC who underwent esophagectomy at Sichuan Cancer Hospital between January 2010 and December 2017. After applying the exclusion criteria, 440 patients were excluded from the analysis. Specifically, 109 patients were excluded due to non-squamous cell carcinoma histology, 56 for tumor locations outside the thoracic region, 148 for R1/R2 resections indicating incomplete tumor removal, 5 for metastases to other organs, 122 for early-stage (pTis/T1a) disease and 7 for missing data. Consequently, a total of 2,510 patients were eligible for the study, as shown in the study flowchart in Fig. 1. A total of 82.1% of the patients (n=2,060) were male and 17.9% (n=450) were female. Approximately 57.5% of the patients (n=1,443) were above stage III, with 5.8% of the patients (n=212) aged >75 years (Table I). Before PSM, there were statistically significant differences between the MS and MeS groups in terms of sex, KPS, smoking history, tumor location, thoracic surgery, abdominal surgery, surgical approach and clinical treatment modality. However, after PSM, these baseline characteristics were well-balanced between the two groups, ensuring comparability for subsequent analyses.
OS
The study included 1,617 (64.4%) patients in the MeS group and 893 (35.6%) patients in the MS group. The median follow-up duration was 63.97 months. Patients in the MeS group had a median OS of 42.67 months (95% CI: 38.55–46.78), while those in the MS group had a median OS of 56.47 months. The 1-, 3- and 5-year OS rates were 86, 54 and 43% for patients in the MeS group, and 87, 60 and 50% for patients in the MS group, respectively [Mes vs. MS hazard ratio (HR): 0.84; 95% CI: 0.75–0.95; P=0.004; Fig. 2]. Following 1:1 PSM, the analysis showed no significant differences between the MeS and MS groups (HR: 0.88; 95% CI: 0.75–1.03; P=0.099; Fig. 3A). Similar results were observed after applying the IPTW, OW and SMRW methods (HR: 0.89; 95% CI: 0.89–1.13; P=0.107; Fig. 3B/HR: 0.91; 95% CI: 0.88–1.13; P=0.102; Fig. 3D and HR: 0.91; 95% CI: 0.91–1.11; P=0.207; Fig. 3E). Fig. 3C illustrates that for the 1:1 PSM, IPTW and OW methods, the standardized mean difference for all variables is <0.1.
Risk factors
Factors significantly affecting OS after esophagectomy were identified through univariate analyses. These factors included drinking (P<0.01), smoking (P<0.01), age (P<0.01), Karnofsky performance status (KPS) scores (P<0.01), sex (P<0.01), thoracic surgical type (P<0.01), abdominal surgical type (P=0.02), surgical approach (P<0.01), tumor grade (P<0.01), lymphovascular invasion (P<0.01), nerve invasion (P<0.01), method of anastomosis (P<0.01), pathological T category (P<0.01), pathological N category (P<0.01) and TNM stage according to the eighth edition (P<0.01; Fig. 4). Multivariate analyses indicated that drinking (P<0.01), age (P<0.01), sex (P=0.03), method of anatomosis (P=0.03), lymphovascular invasion (P=0.04), pathological T3 category (P=0.06), pathological N2 category (P<0.01) and pathological N3 category (P=0.03) were independent influencing factors for OS after esophagectomy compared with other factors (Fig. 4).
Discussion
The impact of mechanical vs. manual suturing techniques on OS in patients undergoing esophagectomy is a critical consideration. In the present study, initially, patients in the MS group showed a superior median OS compared to the MeS group, suggesting a significant influence of the suturing technique on postoperative outcomes. However, subsequent analysis following PSM revealed that the differences between groups were not statistically significant. This implies that when matched for similar baseline characteristics, the choice of suturing technique may not be as crucial for OS as previously thought. The similarity in survival outcomes between MS and MeS provides surgeons with the flexibility to select a technique based on other factors, such as their proficiency, patient-specific anatomical or physiological considerations, and resource availability. Further investigation through univariate and multivariate analyses highlights other factors that have a more substantial impact on survival outcomes. Lifestyle factors like the drinking and smoking status, as well as clinical indicators, such as age, KPS scores, sex, tumor grade and the presence of lymphovascular and nerve invasion, emerge as significant predictors of OS. These results were also confirmed in corresponding studies and emphasized the multifaceted nature of survival following esophagectomy (26), where the surgical technique is just one of several variables influencing patient outcomes.
The ongoing discussion and evolution of treatment strategies for esophageal cancer emphasize a comprehensive approach that combines surgery with various adjuvant therapies to improve patient outcomes (26–29). Surgical resection remains crucial in esophageal cancer treatment, but the complexity of the disease necessitates a comprehensive strategy involving neoadjuvant chemoradiotherapy, chemotherapy, combined chemotherapy and immunotherapy, as well as postoperative immunotherapy maintenance (7,29–32).
The debate among surgical experts revolves around the extent of LN dissection and the decision on thoracic duct resection, both crucial in treating esophageal cancer (33–35). LN involvement is a key factor in predicting adverse outcomes (4,5). The present study showed that there is no statistically significant difference in long-term survival between traditional manual anastomosis and mechanical anastomosis, suggesting both are viable options. The choice should be personalized based on the patient's condition and the surgeon's skill. As we delve deeper into treatment combinations, surgical techniques like LN dissection and thoracic duct management will continue to play a pivotal role. Future research should focus on not just the technical aspects of esophageal cancer surgery but also on integrating these techniques with other treatments to enhance survival, quality of life and patient-centered outcomes.
There are several limitations that should be acknowledged in the present study. The retrospective design of the study, despite using propensity score matching to minimize bias, inherently limits the ability to establish causality. Prospective randomized controlled trials are necessary to definitively compare the efficacy and safety of MS and MeS techniques. The data were collected from a single institution, which may limit the generalizability of the findings. Multi-center studies could provide a more representative overview of outcomes and potentially validate the applicability of these results across different surgical settings and populations. The study focused on OS as the primary endpoint, neglecting other important outcomes such as post-operative recovery, quality of life and complication rates. Furthermore, while the significance of preoperative neoadjuvant therapy, particularly for patients with T2/T3N0-1 ESCC, has been highlighted in studies like CROSS (8) and NEOCRTEC5010As the founder of the Department of Thoracic Surgery, he gave guidance and suggestions for the design and data collection of this study, and also gave guidance on each clinical technical issue at the discussion meeting
Acknowledgements
Not applicable.
Funding
This work was supported by grants from the National Natural Science Foundation of China (grant no. 82472663), the National Key Research and Development Program (grant no. 2022YFC2403400), International Cooperation Projects of the Science and Technology Department of Sichuan Province (grant no. 2024YFHZ0322), the Sichuan Key Research and Development Project from the Science and Technology Department of Sichuan Province (grant nos. 2023YFS0044, 2023YFQ0056 and 2022YFQ0008), the Chengdu Science and Technology Bureau Key Research Project (grant no. 2024-YF05-00797-SN), the Wu Jieping Clinical Research Projects (grant no. 320.6750.2023-05-141) and the Sichuan Province Clinical Key Specialty Construction Project.
Availability of data and materials
The data generated in the present study may be requested from the corresponding author.
Authors' contributions
Study conception and design: SLu, KL, LJ, JX, SLi, ZW, HC, WH, CW, KW, HL, QZ, HZ, QF, QW, YH, LP and XL. Acquisition, analysis or interpretation of data: SLu, KL, LJ, JX, SLi, ZW, HC, WH, CW, KW, HL, QZ, HZ, QF, QW, YH, LP and XL. Drafting of the article: KL. Revising the article critically for important intellectual content: SLu, KL, LJ, JX, SLi, ZW, HC, WH, CW, KW, HL, QZ, HZ, QF, QW, YH, LP and XL. Statistical analysis: SLu. Obtained funding: XL. Administrative, technical or material support: YH and LP. Study supervision: XL, LP. SLu and XL confirm the authenticity of all the raw data. All authors read and approved the final manuscript.
Ethics approval and consent to participate
All procedures performed in this study involving human participants were in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Ethics Committee for Medical Research and New Medical Technology of Sichuan Cancer Hospital (Chengdu, China; approval no. SCCHEC-02-2022-050).
Patient consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Glossary
Abbreviations
Abbreviations:
|
ESCC |
esophageal squamous cell carcinoma |
|
LN |
lymph node |
|
OS |
overall survival |
|
TNM |
tumor-node-metastasis |
|
HR |
hazard ratio |
|
CI |
confidence interval |
|
PSM |
performing propensity score matching |
|
KPS |
Karnofsky performance status |
|
IPTW |
inverse probability of treatment weighting |
|
OW |
overlap weighting |
References
|
Frick C, Rumgay H, Vignat J, Ginsburg O, Nolte E, Bray F and Soerjomataram I: Quantitative estimates of preventable and treatable deaths from 36 cancers worldwide: A population-based study. Lancet Glob Health. 11:e1700–e1712. 2023. View Article : Google Scholar : PubMed/NCBI | |
|
Zheng RS, Chen R, Han BF, Wang SM, Li L, Sun KX, Zeng HM, Wei WW and He J: Cancer incidence and mortality in China, 2022. Zhonghua Zhong Liu Za Zhi. 46:221–231. 2024.(In Chinese). PubMed/NCBI | |
|
Siegel RL, Miller KD, Wagle NS and Jemal A: Cancer statistics, 2023. CA Cancer J Clin. 73:17–48. 2023. View Article : Google Scholar : PubMed/NCBI | |
|
Li K, Nie X, Li C, He W, Wang C, Du K, Li K, Liu K, Li Z, Lu S, et al: Mapping of lymph node metastasis and efficacy index in thoracic esophageal squamous cell carcinoma: A large-scale retrospective analysis. Ann Surg Oncol. 30:5856–5865. 2023. View Article : Google Scholar : PubMed/NCBI | |
|
Tachimori Y, Ozawa S, Numasaki H, Matsubara H, Shinoda M, Toh Y, Udagawa H, Fujishiro M, Oyama T and Uno T; Registration Committee for Esophageal Cancer of the Japan Esophageal Society, : Efficacy of lymph node dissection by node zones according to tumor location for esophageal squamous cell carcinoma. Esophagus. 13:1–7. 2016. View Article : Google Scholar : PubMed/NCBI | |
|
Li K, Leng X, He W, Du K, Li C, Liu K, Wang C, Liu G, Li Z, Jiang L, et al: Resected lymph nodes and survival of patients with esophageal squamous cell carcinoma: an observational study. Int J Surg. 109:2001–2009. 2023.PubMed/NCBI | |
|
Kelly RJ, Ajani JA, Kuzdzal J, Zander T, Van Cutsem E, Piessen G, Mendez G, Feliciano J, Motoyama S, Lièvre A, et al: Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer. N Engl J Med. 384:1191–1203. 2021. View Article : Google Scholar : PubMed/NCBI | |
|
Shapiro J, van Lanschot JJB, Hulshof MCCM, van Hagen P, van Berge Henegouwen MI, Wijnhoven BPL, van Laarhoven HWM, Nieuwenhuijzen GAP, Hospers GAP, Bonenkamp JJ, et al: Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): Long-term results of a randomised controlled trial. Lancet Oncol. 16:1090–1098. 2015. View Article : Google Scholar : PubMed/NCBI | |
|
Yan X, Duan H, Ni Y, Zhou Y, Wang X, Qi H, Gong L, Liu H, Tian F, Lu Q, et al: Tislelizumab combined with chemotherapy as neoadjuvant therapy for surgically resectable esophageal cancer: A prospective, single-arm, phase II study (TD-NICE). Int J Surg. 103:1066802022. View Article : Google Scholar : PubMed/NCBI | |
|
Yang H, Liu H, Chen Y, Zhu C, Fang W, Yu Z, Mao W, Xiang J, Han Y, Chen Z, et al: Neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of the esophagus (NEOCRTEC5010): A phase III multicenter, randomized, open-label clinical trial. J Clin Oncol. 36:2796–2803. 2018. View Article : Google Scholar : PubMed/NCBI | |
|
Alwatari Y, Freudenberger DC, Khoraki J, Bless L, Payne R, Julliard WA, Shah RD and Puig CA: Emergent esophagectomy in patients with esophageal malignancy is associated with higher rates of perioperative complications but no independent impact on short-term mortality. J Chest Surg. 57:160–168. 2024. View Article : Google Scholar : PubMed/NCBI | |
|
Sugiyama F, Kanda M, Shimizu D, Umeda S, Inokawa Y, Hattori N, Hayashi M, Tanaka C, Nakayama G and Kodera Y: Absence of hypercoagulation status after neoadjuvant treatment is associated with favorable prognosis in patients undergoing subtotal esophagectomy for esophageal squamous cell carcinoma. Ann Surg Oncol. 31:3417–3425. 2024. View Article : Google Scholar : PubMed/NCBI | |
|
van der Zijden CJ, van der Sluis PC, Mostert B, Nuyttens JJME, Spaander MCW, Toxopeus ELA, Valkema R, Beerepoot LV, van Halteren HK, Lagarde SM and Wijnhoven BPL: Induction chemotherapy followed by response evaluation and esophagectomy for advanced esophageal cancer. Eur J Surg Oncol. 50:1079682024. View Article : Google Scholar : PubMed/NCBI | |
|
Ercan S, Rice TW, Murthy SC, Rybicki LA and Blackstone EH: Does esophagogastric anastomotic technique influence the outcome of patients with esophageal cancer? J Thorac Cardiovasc Surg. 129:623–631. 2005. View Article : Google Scholar : PubMed/NCBI | |
|
Sugimura K, Miyata H, Matsunaga T, Asukai K, Yanagimoto Y, Takahashi Y, Tomokuni A, Yamamoto K, Hirofumi A, Nishimura J, et al: Comparison of the modified Collard and hand-sewn anastomosis for cervical esophagogastric anastomosis after esophagectomy in esophageal cancer patients: A propensity score-matched analysis. Ann Gastroenterol Surg. 3:104–113. 2019. View Article : Google Scholar : PubMed/NCBI | |
|
Wang Z, Wei Y, Liu X, Li Z, Zhu G, Li Y and Wang K: Application value of hand-sewn anastomosis in totally laparoscopic total gastrectomy for gastric cancer. World J Surg Oncol. 19:2292021. View Article : Google Scholar : PubMed/NCBI | |
|
Chen Z, Wang D, Zhao Q, Yang P, Ding P, Fan H, Dong T, Liu Z, Yang X, Ren L and Li Y: A case series of 10 patients undergone linear cutter/stapler guiding device-led overlapped esophagojejunostomy: A preliminary study. J Gastrointest Oncol. 14:617–625. 2023. View Article : Google Scholar : PubMed/NCBI | |
|
Petrin G, Ruol A, Battaglia G, Buin F, Merigliano S, Constantini M, Pavei P, Cagol M, Scappin S and Ancona E: Anastomotic stenoses occurring after circular stapling in esophageal cancer surgery. Surg Endosc. 14:670–674. 2000. View Article : Google Scholar : PubMed/NCBI | |
|
Orringer MB, Marshall B and Iannettoni MD: Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg. 119:277–288. 2000. View Article : Google Scholar : PubMed/NCBI | |
|
Kondra J, Ong SRY, Clifton J, Evans K, Finley RJ and Yee J: A change in clinical practice: A partially stapled cervical esophagogastric anastomosis reduces morbidity and improves functional outcome after esophagectomy for cancer. Dis Esophagus. 21:422–429. 2008. View Article : Google Scholar : PubMed/NCBI | |
|
Singhal S, Kailasam A, Akimoto S, Masuda T, Bertellotti C and Mittal SK: Simple technique of circular stapled anastomosis in Ivor Lewis esophagectomy. J Laparoendosc Adv Surg Tech A. 27:288–294. View Article : Google Scholar : PubMed/NCBI | |
|
Singh D, Maley RH, Santucci T, Macherey RS, Bartley S, Weyant RJ and Landreneau RJ: Experience and technique of stapled mechanical cervical esophagogastric anastomosis. Ann Thorac Surg. 71:419–424. 2001. View Article : Google Scholar : PubMed/NCBI | |
|
Huang C, Zhao J, Liu Z, Huang J and Zhu Z: Esophageal suspension method for hand-sewn esophagojejunostomy after totally laparoscopic total gastrectomy: A simple, safe, and feasible suturing technique. Front Oncol. 10:5752020. View Article : Google Scholar : PubMed/NCBI | |
|
Sannohe Y, Hiratsuka R, Doki K, Inutsuka S and Hirano M: Mechanical suture methods in Esophago-gastrointestinal anastomosis. Jpn J Surg. 9:313–321. 1979. View Article : Google Scholar : PubMed/NCBI | |
|
Ajani JA, D'Amico TA, Bentrem DJ, Chao J, Corvera C, Das P, Denlinger CS, Enzinger PC, Fanta P, Farjah F, et al: Esophageal and esophagogastric junction cancers, version 2.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 17:855–883. 2019. View Article : Google Scholar : PubMed/NCBI | |
|
Li K, Lu S, Li C, He W, Du K, Liu K, Wang C, Li J, Wang Z, Zhou Y, et al: Long-Term outcomes of smoker and drinker with oesophageal squamous cell carcinoma after oesophagectomy: A Large-scale propensity score matching analysis. BMJ Open Gastroenterol. 11:e0014522024. View Article : Google Scholar : PubMed/NCBI | |
|
Kitagawa Y, Ishihara R, Ishikawa H, Ito Y, Oyama T, Oyama T, Kato K, Kato H, Kawakubo H, Kawachi H, et al: Esophageal cancer practice guidelines 2022 edited by the Japan Esophageal Society: Part 1. Esophagus. 20:343–372. 2023. View Article : Google Scholar : PubMed/NCBI | |
|
Kitagawa Y, Ishihara R, Ishikawa H, Ito Y, Oyama T, Oyama T, Kato K, Kato H, Kawakubo H, Kawachi H, et al: Esophageal cancer practice guidelines 2022 edited by the Japan Esophageal Society: Part 2. Esophagus. 20:373–389. 2023. View Article : Google Scholar : PubMed/NCBI | |
|
Li C, Zhao S, Zheng Y, Han Y, Chen X, Cheng Z, Wu Y, Feng X, Qi W, Chen K, et al: Preoperative pembrolizumab combined with chemoradiotherapy for oesophageal squamous cell carcinoma (PALACE-1). Eur J Cancer. 144:232–241. 2021. View Article : Google Scholar : PubMed/NCBI | |
|
Yu YK, Meng FY, Wei XF, Chen XK, Li HM, Liu Q, Li CJ, Xie HN, Xu L, Zhang RX, et al: Neoadjuvant chemotherapy combined with immunotherapy versus neoadjuvant chemoradiotherapy in patients with locally advanced esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg. 168:417–428.e3. 2024. View Article : Google Scholar : PubMed/NCBI | |
|
Zhou Y, He W, Guo P, Zhou C, Luo M and Liu Y, Yang H, Qin S, Leng X, Huang Z and Liu Y: Development and validation of a recurrence-free survival prediction model for locally advanced esophageal squamous cell carcinoma with neoadjuvant chemoradiotherapy. Ann Surg Oncol. 31:178–191. 2024. View Article : Google Scholar : PubMed/NCBI | |
|
He W, Leng X, Mao T, Luo X, Zhou L, Yan J, Peng L, Fang Q, Liu G, Wei X, et al: Toripalimab plus paclitaxel and carboplatin as neoadjuvant therapy in locally advanced resectable esophageal squamous cell carcinoma. Oncologist. 27:e18–e28. 2022. View Article : Google Scholar : PubMed/NCBI | |
|
Li K, Du K, Liu K, Nie X, Li C, He W, Li K, Wang C, Li Z, Zheng K, et al: Impact of two-field or three-field lymphadenectomy on overall survival in middle and lower thoracic esophageal squamous cell carcinoma: A single-center retrospective analysis. Oncol Lett. 25:1892023. View Article : Google Scholar : PubMed/NCBI | |
|
Li B, Zhang Y, Miao L, Ma L, Luo X, Zhang Y, Ye T, Li H, Zhang J, Li Y, et al: sophagectomy with three-field versus two-field lymphadenectomy for middle and lower thoracic esophageal cancer: Long-term outcomes of a randomized clinical trial. J Thorac Oncol. 16:310–217. 2021. View Article : Google Scholar : PubMed/NCBI | |
|
Oshikiri T, Numasaki H, Oguma J, Toh Y, Watanabe M, Muto M, Kakeji Y and Doki Y: Prognosis of patients with esophageal carcinoma after routine thoracic duct resection: A propensity-matched analysis of 12,237 patients based on the comprehensive registry of esophageal cancer in Japan. Ann Surg. 277:e1018–e1025. 2023. View Article : Google Scholar : PubMed/NCBI |
