P46 TRANSTHORACIC VERSUS TRANSHIATAL ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A NATION-WIDE PROPENSITY SCORE MATCHED COHORT ANALYSIS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Kalff MC ◽  
Mertens AC ◽  
Eshuis WJ ◽  
van Berge Henegouwen Prof MI ◽  
Gisbertz SS
Keyword(s):  
Lymph Node ◽  
Mortality Rate ◽  
Propensity Score ◽  
Lymph Nodes ◽  
Propensity Score Matching ◽  
Lymph Node Dissection ◽  
Transhiatal Esophagectomy ◽  
Early Mortality ◽  
Node Dissection ◽  
Extensive Lymph Node

Abstract Aim The current study aims to compare transthoracic and transhiatal esophagectomy in a propensity score matched nation-wide cohort study. Background & Methods Chemoradiotherapy followed by resection is the standard therapy for resectable esophageal carcinoma in the Netherlands. The optimal surgical approach remains a matter of debate. Data was acquired from the Dutch Upper-GI Cancer Audit. Patients who underwent esophagectomy with curative intent and gastric tube reconstruction for mid/distal esophageal or esophagogastric junction carcinoma from 2011-2016 were included. Patients with missing baseline data and patients undergoing emergency or hybrid surgery were excluded. Patients who underwent a transthoracic (TTE) or transhiatal (THE) esophagectomy were compared after propensity score matching. Results After propensity score matching, 1532 patients were included for analysis. The transthoracic approach yielded more lymph nodes (median 19 vs 14; p<0.001). There was no difference in the number of positive lymph nodes, however, the median (y)pN-stage was higher after TTE (p=0.044). The TTE group experienced more chyle leakage (9.7% vs 2.7%, p<0.001) and more pulmonary (35.5% vs 26.1%, p<0.001) and cardiac complications (15.4% vs 10.3%, p=0.003). The TTE group required a longer hospital stay (median 14 vs 11 days, p<0.001), ICU stay (median 3 vs 1 day, p<0.001) and had a higher early mortality rate (4.0% vs 1.7%, p=0.009). Subgroup analysis on anastomotic level showed that TTE with intrathoracic anastomosis (TTEi) had a significantly lower recurrent nerve lesion incidence (0.5%) compared to TTE with cervical anastomosis (TTEc) (7.4%, p=<0.001) and THE (5.9%, p=<0.001). There was no statistical difference in anastomotic leakage rates on anastomotic level, however incidence was lowest after TTEi (TTEc 21.5%, TTEi 15.1%, THE 19.5%). The higher early mortality rate after TTE was mainly caused by TTEc (4.6%), however, only the difference of early mortality between TTEc and THE (1.7%) reached statistical significance (p=0.006). Conclusion TTE provided a more extensive lymph node dissection which resulted in a higher N-stage, at the cost of increased morbidity and short-term mortality. Although results in high-volume centers are often superior, these data reflect nationwide results. Future research should investigate if a more extensive lymph node dissection leads to an improved long-term survival.

scholarly journals Transthoracic Versus Transhiatal Esophagectomy for Esophageal Cancer: A Nationwide Propensity Score-Matched Cohort Analysis

2020 ◽  
Vol 28 (1) ◽  
pp. 175-183
Author(s):  
Alexander C. Mertens ◽  
◽  
Marianne C. Kalff ◽  
Wietse J. Eshuis ◽  
Thomas M. Van Gulik ◽  
...  
Keyword(s):  
Lymph Node ◽  
Propensity Score ◽  
Lymph Nodes ◽  
Propensity Score Matching ◽  
Cohort Analysis ◽  
Transhiatal Esophagectomy ◽  
Cardiac Complications ◽  
Matched Cohort ◽  
Transthoracic Approach ◽  
Lymph Node Yield

Abstract Background Chemoradiation followed by resection has been the standard therapy for resectable (cT1-4aN0-3M0) esophageal carcinoma in the Netherlands since 2010. The optimal surgical approach remains a matter of debate. Therefore, the purpose of this study was to compare the transhiatal and the transthoracic approach concerning morbidity, mortality and oncological quality. Methods Data was acquired from the Dutch Upper GI Cancer Audit. Patients who underwent esophagectomy with curative intent and gastric tube reconstruction for mid/distal esophageal or esophagogastric junction carcinoma (cT1-4aN0-3M0) from 2011 to 2016 were included. Patients who underwent a transthoracic and transhiatal esophagectomy were compared after propensity score matching. Results After propensity score matching, 1532 of 4143 patients were included for analysis. The transthoracic approach yielded more lymph nodes (transthoracic median 19, transhiatal median 14; p < 0.001). There was no difference in the number of positive lymph nodes, however, the median (y)pN-stage was higher in the transthoracic group (p = 0.044). The transthoracic group experienced more chyle leakage (9.7% vs. 2.7%, p < 0.001), more pulmonary complications (35.5% vs. 26.1%, p < 0.001), and more cardiac complications (15.4% vs. 10.3%, p = 0.003). The transthoracic group required a longer hospital stay (median 14 vs. 11 days, p < 0.001), ICU stay (median 3 vs. 1 day, p < 0.001), and had a higher 30-day/in-hospital mortality rate (4.0% vs. 1.7%, p = 0.009). Conclusions In a propensity score-matched cohort, the transthoracic esophagectomy provided a more extensive lymph node dissection, which resulted in a higher lymph node yield, at the cost of increased morbidity and short-term mortality.

scholarly journals Long-Term Outcomes of Laparoscopic Versus Open Gastrectomy With D2 Lymph Node Dissection for Advanced Gastric Cancer

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 225s-225s
Author(s):  
Z. Li
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Propensity Score Matching ◽  
Lymph Node Dissection ◽  
Node Dissection ◽  
Long Term Outcomes ◽  
D2 Lymph Node Dissection

Background: Technical safety and short-term surgical outcomes of laparoscopy-assisted gastrectomy (LAG) for advanced gastric cancer (AGC) have been investigated in many clinical trials. However, studies with large sample size and sufficient follow-up comparing LAG and open gastrectomy (OG) for AGC have seldom been reported. Aim: The purpose of this study was to compare the long-term outcomes of LAG vs open OG for AGC using a propensity score matching analysis. Methods: We retrospectively evaluated 459 and 856 patients who underwent LG or OG with D2 lymph node dissection, respectively, for AGC between June 2007 and June 2012. One-to-one propensity score matching was performed to compensate for heterogeneity between groups. We compared long-term outcomes between the 2 groups after propensity score matching. Results: In the propensity score-matched cohort, no significant differences were observed in 5-year overall survival (OS) (52.0% vs 53.4%; P = 0.805) and disease-free survival (DFS) (46.8% vs 47.3%; P = 0.963) between the LAG group and OG group. Stratified analysis showed that the 5-year OS and DFS rates were comparable between the 2 groups in each tumor stage ( P > 0.05). Multivariate analysis revealed that the operation method was not an independent prognostic factor for OS or DFS. Further analysis showed that the recurrence pattern was similar between the LAG group the OG group ( P > 0.05). Conclusion: LAG is a feasible surgical procedure for AGC in comparison with OG in terms of long-term prognosis, although the results should be confirmed by the ongoing randomized controlled trials.

scholarly journals Pelvic lymph node dissection and its extent on survival benefit in prostate cancer patients with a risk of lymph node invasion >5%: a propensity score matching analysis from SEER database

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Junru Chen ◽  
Zhipeng Wang ◽  
Jinge Zhao ◽  
Sha Zhu ◽  
Guangxi Sun ◽  
...  
Keyword(s):  
Lymph Node ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Lymph Node Dissection ◽  
Cox Regression ◽  
Pelvic Lymph Node Dissection ◽  
Pelvic Lymph Node ◽  
Seer Database ◽  
Node Dissection ◽  
Significant Difference

AbstractPelvic lymph node dissection (PLND) represents the gold standard for nodal staging in PCa and is recommended for patients with a probability of lymph node invasion (LNI) >5%. However, the therapeutic role of PLND and its extent remains a debate. In this study, data of 20,668 patients treated with radical prostatectomy (RP) with and without PLND from SEER database between 2010 and 2015 were retrospectively analyzed. All patients had a risk of LNI >5% according to 2012-Briganti nomogram. Propensity score matching (PSM) was performed to balance baseline characteristics between patients with and without PLND. Kaplan-Meier curves and Cox regression were used to evaluate the impacts of the PLND and its extent on cancer-specific survival (CSS) and overall survival (OS). In overall cohort, patients with PLND were associated with more aggressive clinicopathologic characteristics and had poorer survival compared to those without PLND (5-year CSS rate: 98.4% vs. 99.7%, p < 0.001; 5-year OS rate: 96.3% vs. 97.8%, p < 0.001). In the post-PSM cohort, no significant difference in survival was found between patients with and without PLND (5-year CSS rate: 99.4% vs. 99.7%, p = 0.479; 5-year OS rate: 97.3% vs. 97.8%, p = 0.204). In addition, the extent of PLND had no impact on prognosis (all p > 0.05). Subgroup analyses reported similar negative findings. In conclusion, neither PLND nor its extent was associated with survival in North American patients with a risk of LNI >5%. The cut-off point of 5% probability of LNI might be too low to show benefits in survival in patients underwent PLND.

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