ObjectiveTo explore whether surgery combined with adjuvant chemotherapy can bring survival benefits to patients with cervical and upper thoracic esophageal squamous cell carcinoma (ESCC).MethodsThe clinical data of patients with cervical and upper thoracic ESCC who underwent R0 resection and neck anastomosis in our department from 2006 to 2010 were retrospectively analyzed. Patients received neoadjuvant therapy or adjuvant radiotherapy were excluded. The adjuvant chemotherapy group was given a combination of taxanes and platinum based chemotherapy after surgery; the surgery alone group did not receive adjuvant chemotherapy. The Kaplan-Meier method was used to analyze the survival difference between the adjuvant chemotherapy group and the surgery alone group. ResultsA total of 181 patients were enrolled, including 141 (77.9%) males and 40 (22.1%) females, with an average age of 61.0±8.2 years (80 patients aged≤61 years, 101 patients aged>61 years). There were 70 (38.7%) patients of cervical ESCC, and 111 (61.3%) patients of upper thoracic ESCC. Eighty-seven (48.1%) patients underwent postoperative adjuvant chemotherapy, and 94 (51.9%) patients underwent surgery alone, and the basic clinical characteristics were well balanced between the two groups (P>0.05). The median survival time of patients in the adjuvant chemotherapy group and the surgery alone group was 31.93 months and 26.07 months, and the 5-year survival rate was 35.0% and 32.0%, respectively (P=0.227). There was no statistical difference in median survival time between the cervical ESCC and upper thoracic ESCC group (31.83 months vs. 29.76 months, P=0.763). For cervical ESCC patients, the median survival time was 45.07 months in the adjuvant chemotherapy group and 14.70 months in the surgery alone group (P=0.074). Further analysis showed that the median survival time of lymph node negative group was 32.53 months, and the lymph node positive group was 24.57 months (P=0.356). The median survival time was 30.43 months in the lymph-node positive group with adjuvant chemotherapy and 17.77 months in the lymph-node positive group with surgery alone. The survival curve showed a trend of difference, but the difference was not statistically significant (P=0.557).ConclusionThere is no statistical difference in the long-term survival of cervical and upper thoracic ESCC patients after R0 resection. Postoperative adjuvant chemotherapy may have survival benefits for patients with cervical ESCC and upper ESCC with postoperative positive lymph nodes, but the differences are not statistically significant in this setting.
Objective To compare the differences between the up-lobectomy by single-microport assisted micro-uni-port thoracoscopy surgery and traditional uni-portal video assisted thoracic surgery, summarize and analyze the technical points of single-microport assisted micro-uni-port thoracoscopy surgery, and explore the surgical effect and value of promotion. Methods We retrospectively analyzed the clinical data of patients who underwent radical upper lobectomy at the Thoracic Surgery Department of Xi’an International Medical Center Hospital from March 2023 to June 2024. The patients were divided into two groups according the surgical procedure: a single-micromini-assisted group (patients underwent up-lobectomy by single-microport assisted micro-uni-port thoracoscopy) and a traditional uniportal group (patients underwent traditional uniportal thoracoscopic lobectomy). Clinical outcomes were compared between the two groups. Results We finally included 62 patients. There were 30 patients with 16 males and 14 females at an average of 57.4±10.8 years in the the single-micromini-assisted group and 32 patients with 20 males and 12 females at an average age of 57.6±8.7 years in the traditional uni-port thoracoscopy group. Both groups successfully completed minimally invasive surgery.The baseline data were consistent between the two groups. The operation time was shorter in the single microport assisted group [(146.03±30.79) min vs. (171.41±36.41) min, P=0.004] than that in the traditional uni-port thoracoscopy group with a statistical difference. There was no statistical difference between the two groups in terms of intraoperative blood loss, postoperative pain score, dissected lymph node number, postoperative drainage volume, postoperative tube time, postoperative hospital stay, hospitalization cost, or the incidence of postoperative complications (P>0.05). Conclusion Single-microport assisted micro-uni-port thoracoscopy surgery can maximize the advantages of three-portal and uni-portal VATS, and effectively avoid the disadvantages of three-portal and uni-portal VATS, which can significantly shorten the operation time, without increasing the postoperative pain and complications, is a more minimally invasive, safer and more convenient surgical method.