·To review the results of surgical treatment for the patients with stage Ⅰ esophageal squamous cell carcinoma, analyze the clinical biological characteristics, and determine whether surgical treatment is a recommended curative strategy.Methods
·A total of 379 patients undergoing esophagectomy with stage Ⅰ squamous cell esophageal carcinoma from 2015 to 2019 in Shanghai Chest Hospital, Shanghai Jiao Tong University, were reviewed. The stage definition was determined according to the 8th edition of the American Joint Committee on Cancer (AJCC ) cancer staging manual. Survival was calculated using the Kaplan-Meier method and was then compared by the Log-rank test. Univariate and multivariate analysis with the Cox proportional hazards model was used to investigate the effect of different factors on survival, including age, gender, pathological T stage, clinical T stage, tumor diameter, the number of dissected lymph nodes.Results
·Three hundred and seventy-nine patients were included, accounting for 11.9% of all of patients undergoing esophagectomy during the same period. Male accounted for 79.2%. Tumors were located in the upper, middle, and lower segments of thoracic esophagus at 14.2%, 43.8%, and 42.0%. A total of 81.5% of patients underwent minimally invasive surgery. The R0 resection rate was 96.0%. The average number of lymph node dissections was 18.0±9.3. The incidence of postoperative complications of the Clavien-Dindo grade Ⅲ or higher was 20.8%. The incidences of anastomotic fistula, recurrent laryngeal nerve injury, pneumonia, and respiratory insufficiency were 12.4%, 14.2%, 13.5% and 2.9%, respectively. The 30-d and 90-d mortality rates were 0.5% and 1.3%, respectively. Postoperative surgical pathology showed that T1a, T1b and T2 ratios were 20.6%, 69.4% and 10.0%. The diameter of tumor in surgical sample was (2.1±1.1) cm, but larger in preoperative endoscopy evaluation [(3.2±2.2) cm], and the lymphovascular invasion rate was 5.8%. The follow-up time was 1 to 61 months, and the median follow-up time was 24 months. During the follow-up, the overall recurrence rate was 8.2%, and the local recurrence rate and distant metastasis rate were 7.4% and 2.9%, respectively. Univariate analysis showed that the factors of age and number of dissected lymph nodes were related to overall survival (OS) (P=0.025, P=0.011), while clinical and pathological T stage and number of dissected lymph nodes were related to disease-free survival (DFS) (P=0.017, P=0.005, P=0.001). Multivariate analysis showed that the independent risk factors for OS were older than 65 years, less than 15 lymph node dissections. The independent risk factors for DFS were less than 15 lymph node dissections, clinical stage T2 or T3.Conclusions
·Patients with stage Ⅰ esophageal squamous cell carcinoma can obtain satisfactory tumor control and long-term survival after surgical treatment based on minimally invasive surgery. More thorough lymph node dissection would be the key to improve the current prognosis.