Kernstine K H, DeArmond D T, Shamoun D M, Campos J H
Department of Thoracic Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Warsaw MOB, Suite 2001G, Duarte, CA 91010-3000, USA.
Surg Endosc. 2007 Dec;21(12):2285-92. doi: 10.1007/s00464-007-9405-7. Epub 2007 Jun 26.
This study investigated the use of robotics to perform extended esophageal resection in a series of patients.
A total of 14 patients with a median age of 64 years underwent esophagectomy using the da Vinci robot. At presentation, there were 12 cases of cancer, staged at T2N1 (n = 2), T3N0 (n = 2), T3N1 (n = 6), T4N1 (n = 1), and M1a (n = 1); 2 cases of high-grade dysplasia; 8 cases of adenocarcinoma; and 4 cases of squamous cell cancer; as well as 2 middle third, 9 lower third, and one gastroesophageal junction tumor. Nine patients had undergone preoperative chemoradiotherapy, and six had undergone prior abdominal surgery. The patients were categorized into three chronological groups according to the procedure performed. Group 1 consisted of the first three patients in the series, whose surgery was thoracic only (robotically assisted esophagectomy). Group 2, the next three patients, had robotically assisted thoracic esophagectomy plus thoracic duct ligation using a laparoscopic gastric conduit. Group 3, the last eight patients, underwent completely robotic esophagectomy.
For Group 3, the total operating room time was 11.1 +/- 0.8 h (range, 11.3-13.2 h), with a console time of 5.0 +/- 0.5 h (range, 4.8-5.8 h). The estimated blood loss was 400 +/- 300 ml (range, 200-950 ml). One patient in group 1 had a thoracic duct leak. In groups 2 and 3, thoracic duct ligation resulted in no further leaks. Other postoperative complications included severe pneumonia (1 case), atrial fibrillation (5 cases), cervical anastomotic leak (2 cases), wound infection (1 case), and bilateral vocal cord paresis requiring tracheostomy (1 case). In seven of the cases, no intensive care unit time was required. There was one death from pneumonia 72 days after the procedure. The rate of disease-free survival was 87%.
The robotic approach facilitates an extended three-field esophagolymphadenectomy even after induction therapy and abdominal surgery. Larger scale trials are needed to define the role of this technique.
本研究调查了在一系列患者中使用机器人技术进行扩大食管切除术的情况。
共有14例患者，中位年龄64岁，使用达芬奇机器人进行了食管切除术。就诊时，有12例癌症患者，分期为T2N1（n = 2）、T3N0（n = 2）、T3N1（n = 6）、T4N1（n = 1）和M1a（n = 1）；2例高级别异型增生；8例腺癌；4例鳞状细胞癌；以及2例食管中段、9例食管下段和1例胃食管交界部肿瘤。9例患者接受了术前放化疗，6例患者曾接受过腹部手术。根据所施行的手术，将患者按时间顺序分为三组。第1组包括该系列中的前3例患者，其手术仅为胸部手术（机器人辅助食管切除术）。第2组，接下来的3例患者，接受了机器人辅助胸段食管切除术加使用腹腔镜胃管道进行胸导管结扎术。第3组，最后8例患者，接受了完全机器人食管切除术。
对于第3组，总手术时间为11.1±0.8小时（范围，11.3 - 13.2小时），控制台时间为5.0±0.5小时（范围，4.8 - 5.8小时）。估计失血量为400±300毫升（范围，200 - 950毫升）。第1组中有1例患者发生胸导管漏。在第2组和第3组中，胸导管结扎术后未再发生漏液。其他术后并发症包括严重肺炎（1例）、心房颤动（5例）、颈部吻合口漏（2例）、伤口感染（1例）以及双侧声带麻痹需要气管切开术（1例）。在7例病例中，无需入住重症监护病房。术后72天有1例患者死于肺炎。无病生存率为87%。
即使在诱导治疗和腹部手术后，机器人手术方法也有助于进行扩大的三野食管淋巴结清扫术。需要进行更大规模的试验来确定该技术的作用。
