Coker Alisa M, Barajas-Gamboa Juan S, Cheverie Joslin, Jacobsen Garth R, Sandler Bryan J, Talamini Mark A, Bouvet Michael, Horgan Santiago
Department of Surgery, University of California San Diego , La Jolla, California.
J Laparoendosc Adv Surg Tech A. 2014 Feb;24(2):89-94. doi: 10.1089/lap.2013.0444. Epub 2014 Jan 8.
We previously reported our experience performing robotic-assisted transhiatal esophagectomy (RATE) in patients with early-stage esophageal cancer who had had no preoperative treatment. The purpose of this report was to determine if RATE could be performed safely with good outcomes for esophageal cancer in a more recent series of patients, the majority of whom were treated with neoadjuvant chemoradiation.
This was a retrospective review of patients with adenocarcinoma of the distal esophagus or gastroesophageal junction who underwent RATE between November 2006 and November 2012 at a single tertiary-care hospital. Main outcome measures included operative and oncologic parameters, morbidity, and mortality.
In total, 23 patients underwent RATE, consisting of 20 men and 3 women with a median age of 64 years (range, 40-81 years). The majority of patients (19/23 [83%]) underwent neoadjuvant chemoradiation, although 1 patient had preoperative chemotherapy only, and 3 patients went straight to surgery. Median operative time was 231 minutes (range, 179-319 minutes), and median estimated blood loss was 100 mL (range, 25-400 mL). There were no conversions to open surgery. Complications included seven strictures, two anastomotic leaks, and two pericardial/pleural effusions requiring drainage. One patient required pyloroplasty 3 months after esophagectomy. One patient died from pulmonary failure 21 days after surgery (30-day mortality rate of 4%). The median length of stay was 9 days (range, 7-37 days). Seven of the 19 patients who underwent preoperative chemoradiation had a complete response on final pathology. The mean lymph node yield was 15 (range, 5-29), and surgical margins were negative for cancer in 21 cases.
RATE can be performed safely with good oncologic outcomes following neoadjuvant chemoradiation in patients with esophageal cancer. This technique has become our choice of operation for most patients with esophageal cancer.
我们之前报道了在未接受术前治疗的早期食管癌患者中进行机器人辅助经裂孔食管切除术（RATE）的经验。本报告的目的是确定在最近一系列患者中，RATE对食管癌患者能否安全实施并取得良好疗效，这些患者大多数接受了新辅助放化疗。
这是一项对2006年11月至2012年11月在一家三级医疗中心接受RATE的远端食管癌或胃食管交界腺癌患者的回顾性研究。主要观察指标包括手术和肿瘤学参数、发病率和死亡率。
共有23例患者接受了RATE，其中20例男性，3例女性，中位年龄64岁（范围40 - 81岁）。大多数患者（19/23 [83%]）接受了新辅助放化疗，尽管1例患者仅接受了术前化疗，3例患者直接接受手术。中位手术时间为231分钟（范围179 - 319分钟），中位估计失血量为100 mL（范围25 - 400 mL）。无中转开腹手术。并发症包括7例狭窄、2例吻合口漏和2例需要引流的心包/胸腔积液。1例患者在食管切除术后3个月需要进行幽门成形术。1例患者术后21天死于呼吸衰竭（30天死亡率为4%）。中位住院时间为9天（范围7 - 37天）。19例接受术前放化疗的患者中有7例最终病理完全缓解。平均淋巴结收获数为15个（范围5 - 29个），21例手术切缘无癌。
在接受新辅助放化疗的食管癌患者中，RATE可以安全实施并取得良好的肿瘤学疗效。这项技术已成为我们大多数食管癌患者的手术选择。
