Analysis of clinical efficacy of radical esophagectomy for esophageal cancer using different minimally invasive approaches

doi:10.3969/j.issn.1674-8115.2026.08.009

Abstract

Abstract:

Objective ·To evaluate and compare the efficacy of three types of radical esophagectomy for esophageal cancer. Methods ·The clinical data of 298 patients who underwent radical esophagectomy were retrospectively analyzed. The patients were divided into three groups based on the surgical approach: the synchronous insufflation mediastinoscopy with laparoscopy esophagectomy (SIMLE) group, the combined insufflation mediastinoscopy-laparoscopy esophagectomy (CIMLE) group, and the McKeown group. Propensity score matching (PSM) was performed at a 1∶1 ratio for pairwise stratification matching between groups. Differences among the groups were analyzed in terms of preoperative baseline data, operative time, intraoperative blood loss, indicators of internal homeostasis, postoperative complications, number of lymph nodes dissected, and postoperative recovery status. Results ·After PSM, 75 pairs were matched between the SIMLE and CIMLE groups, and 88 pairs between the SIMLE and McKeown groups. Operative time and intraoperative blood loss in the SIMLE group were significantly lower than those in the CIMLE and McKeown groups (all P<0.001). At the end of anesthesia induction, indicators of internal homeostasis, including pH value, glucose, base excess, and lactate levels, in the SIMLE group were superior to those in the CIMLE and McKeown groups (all P<0.05). The SIMLE group also showed better outcomes than the other two groups in terms of complications such as anastomotic leakage and anastomotic stricture (P<0.05). The postoperative hospital stay in the SIMLE group was shorter than that in the CIMLE and McKeown groups (both P<0.001). At 7 days postoperatively, levels of interleukin-6, tumor necrosis factor-ɑ, and C-reactive protein in the SIMLE group were significantly lower than those in the CIMLE and McKeown groups (all P<0.05). At 14 days postoperatively, recovery of prealbumin and albumin levels was better in the SIMLE group (all P<0.05). Within 1 month after surgery, the SIMLE group had significantly higher scores on the 15-item Quality of Recovery-15 (QoR-15) scale compared to the CIMLE and McKeown groups (all P<0.05). Conclusion ·The SIMLE procedure, through synchronous operation using mediastinoscopy and laparoscopy, can shorten operative time, reduce surgical stress, and accelerate postoperative recovery, providing a new minimally invasive treatment option for patients with esophageal cancer.

Key words: synchronous insufflation mediastinoscopy with laparoscopic esophagectomy (SIMLE), combined insufflation mediastinoscopy-laparoscopy esophagectomy (CIMLE), McKeown esophagectomy, radical esophagectomy for esophageal cancer, clinical efficacy

CLC Number:

R735.1

Yuan Wandi, Zhu Ziyin, Zhao Zuyuan, Yao Shuhuan, Sun Xiang, Wei Haitao, Li Li, Li Minhui. Analysis of clinical efficacy of radical esophagectomy for esophageal cancer using different minimally invasive approaches[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026,(8): 1091-1100.

Figures/Tables 14

TrendMD

References 12

[1]	Yang H, Wang F, Hallemeier C L, et al. Oesophageal cancer[J]. Lancet, 2024, 404(10466): 1991-2005.
[2]	Zhu H C, Ma X, Ye T, et al. Esophageal cancer in China: practice and research in the new era[J]. Int J Cancer, 2023, 152(9): 1741-1751.
[3]	Zhang Y J, Dong D, Cao Y Q, et al. Robotic versus conventional minimally invasive esophagectomy for esophageal cancer: a meta-analysis[J]. Ann Surg, 2023, 278(1): 39-50.
[4]	舒欣, 朱易紫婷, 李雨捷, 等. 《食管癌手术加速康复策略麻醉专家共识》解读[J]. 西部医学, 2024, 36(12): 1717-1721.
	Shu X, Zhu Y Z T, Li Y J, et al. Interpretation of expert consensus on anesthesia in enhanced recovery after surgery for esophageal cancer surgery[J]. Medical Journal of West China, 2024, 36(12): 1717-1721.
[5]	卢万里, 王俊钢, 郝蒙福. 充气纵隔镜与胸腔镜联合腹腔镜手术治疗早期食管癌的临床效果比较[J]. 河南医学研究, 2025, 34(3): 460-463.
	Lu W L,Wang J G, Hao M F. Comparison of clinical effects on pneumatic mediastinoscopy and thoracoscopic combined with laparoscopic surgery in the treatment of early esophageal cancer[J]. Henan Medical Research, 2025,34(3):460-463.
[6]	Tejada B, Giannaris E S, Hashemi S, et al. Comparison of the ivor-lewis vs McKeown procedure in esophageal cancers: an updated meta-analysis and systematic review[J]. Am Surg, 2025, 91(11): 1974-1982.
[7]	Booka E, Takeuchi H. Current advances and challenges in minimally invasive esophagectomy[J]. Int J Clin Oncol, 2025, 30(8): 1463-1474.
[8]	Fujita T. Robot-assisted transcervical esophagectomy for thoracic esophageal carcinoma[J]. J Chest Surg, 2025, 58(5): 209-213.
[9]	张锋, 许诺, 韦海涛, 等. 充气式纵隔镜同步腹腔镜对比McKeown术式治疗食管癌的回顾性队列对比研究[J]. 中国肿瘤临床, 2026, 53(3): 109-115.
	Zhang F, Xu N, Wei H T, et al. A retrospective cohort comparative study of pneumatic mediastinoscopic synchronous laparoscopy versus the McKeown procedure for the treatment of esophageal cancer[J]. Chinese Journal of Clinical Oncology, 2026, 53(3): 109-115.
[10]	Stark P A, Myles P S, Burke J A. Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15[J]. Anesthesiology, 2013, 118(6): 1332-1340.
[11]	Ofuchi T, Kosumi K, Iwatuski M. Advancing surgical options in esophageal cancer: key findings from the ROMIO randomized clinical trial[J]. J Thorac Dis, 2025, 17(1): 5-9.
[12]	Patton A, Davey M G, Quinn E, et al. Minimally invasive vs open vs hybrid esophagectomy for esophageal cancer: a systematic review and network meta-analysis[J]. Dis Esophagus, 2024, 37(12): doae086.

Clinical data	SIMLE group (n=103)	CIMLE group (n=94)	McKeown group (n=101)	Statistic value	P value
Gender/n				0.124	0.940
Male	56	50	55
Female	47	44	46
Age/year	63.6±6.2	62.9±6.0	63.2±6.2	0.323	0.724
BMI/(kg·m^-2)	21.8±3.4	21.5±3.2	21.3±3.0	0.629	0.534
Tumor differentiation/n				0.125	0.998
Low	30	28	30
Moderate	58	52	57
High	15	14	14
Tumor location/n				0.265	0.992
Upper	34	30	32
Middle	35	32	34
Lower	34	32	35
Tumor diameter/n				0.536	0.765
<3 cm	65	64	66
3‒5 cm	38	30	35
Pathological type/n				1.086	0.897
Squamous cell carcinoma	49	50	52
Adenocarcinoma	46	38	40
Other	8	6	9
Tumor stage/n				0.172	0.999
Ⅰ	21	20	20
Ⅱ	41	38	41
Ⅲ	41	36	40
Neoadjuvant therapy/n				0.744	0.689
Yes	80	68	75
No	23	26	26
Comorbidity/n
Hypertension	13	10	11	0.232	0.890
Diabetes mellitus	16	13	15	0.114	0.944

Clinical data	SIMLE group (n=103)	CIMLE group (n=94)	McKeown group (n=101)	Statistic value	P value
Gender/n				0.124	0.940
Male	56	50	55
Female	47	44	46
Age/year	63.6±6.2	62.9±6.0	63.2±6.2	0.323	0.724
BMI/(kg·m^-2)	21.8±3.4	21.5±3.2	21.3±3.0	0.629	0.534
Tumor differentiation/n				0.125	0.998
Low	30	28	30
Moderate	58	52	57
High	15	14	14
Tumor location/n				0.265	0.992
Upper	34	30	32
Middle	35	32	34
Lower	34	32	35
Tumor diameter/n				0.536	0.765
<3 cm	65	64	66
3‒5 cm	38	30	35
Pathological type/n				1.086	0.897
Squamous cell carcinoma	49	50	52
Adenocarcinoma	46	38	40
Other	8	6	9
Tumor stage/n				0.172	0.999
Ⅰ	21	20	20
Ⅱ	41	38	41
Ⅲ	41	36	40
Neoadjuvant therapy/n				0.744	0.689
Yes	80	68	75
No	23	26	26
Comorbidity/n
Hypertension	13	10	11	0.232	0.890
Diabetes mellitus	16	13	15	0.114	0.944

Clinical data	SIMLE group (n=75)	CIMLE group (n=75)	Statistic value	P value
Gender/n			‒	1.000
Male	41	41
Female	34	34
Age/year	63.5±6.1	63.4±6.0	0.102	0.921
BMI/(kg·m^-2)	21.75±3.35	21.68±3.25	0.182	0.856
Tumor differentiation/n			0.485	0.628
Low	22	21
Moderate	42	43
High	11	11
Tumor location/n			0.158	0.924
Upper	25	24
Middle	26	27
Lower	24	24
Tumor diameter/n			0.133	0.715
<3 cm	49	48
3‒5 cm	26	27
Pathological type/n			0.215	0.898
Squamous cell carcinoma	38	37
Adenocarcinoma	31	32
Other	6	6
Tumor stage/n			0.412	0.680
Ⅰ	15	14
Ⅱ	32	33
Ⅲ	28	28
Neoadjuvant therapy/n			0.300	0.584
Yes	58	57
No	17	18
Comorbidity/n			‒	1.000
Hypertension	10	10
Diabetes mellitus	12	11

Clinical data	SIMLE group (n=75)	CIMLE group (n=75)	Statistic value	P value
Gender/n			‒	1.000
Male	41	41
Female	34	34
Age/year	63.5±6.1	63.4±6.0	0.102	0.921
BMI/(kg·m^-2)	21.75±3.35	21.68±3.25	0.182	0.856
Tumor differentiation/n			0.485	0.628
Low	22	21
Moderate	42	43
High	11	11
Tumor location/n			0.158	0.924
Upper	25	24
Middle	26	27
Lower	24	24
Tumor diameter/n			0.133	0.715
<3 cm	49	48
3‒5 cm	26	27
Pathological type/n			0.215	0.898
Squamous cell carcinoma	38	37
Adenocarcinoma	31	32
Other	6	6
Tumor stage/n			0.412	0.680
Ⅰ	15	14
Ⅱ	32	33
Ⅲ	28	28
Neoadjuvant therapy/n			0.300	0.584
Yes	58	57
No	17	18
Comorbidity/n			‒	1.000
Hypertension	10	10
Diabetes mellitus	12	11

Clinical data	SIMLE group(n=88)	McKeown group (n=88)	Statistic value	P value
Gender/n			‒	1.000
Male	48	48
Female	40	40
Age/year	63.6±6.2	63.3±6.1	0.326	0.745
BMI/(kg·m^-2)	21.82±3.38	21.55±3.10	0.415	0.679
Tumor differentiation/n			0.721	0.471
Low	26	25
Moderate	49	50
High	13	13
Tumor location/n			0.412	0.814
Upper	29	28
Middle	30	31
Lower	29	29
Tumor diameter/n			‒	1.000
<3 cm	57	57
3‒5 cm	31	31
Pathological type/n			0.137	0.934
Squamous cell carcinoma	44	43
Adenocarcinoma	39	40
Other	5	5
Tumor stage/n			0.256	0.798
Ⅰ	18	17
Ⅱ	37	38
Ⅲ	33	33
Neoadjuvant therapy/n			1.000	0.317
Yes	67	65
No	21	23
Comorbidity/n			‒	1.000
Hypertension	11	11
Diabetes mellitus	14	14