Trugeda Carrera M Soledad, Fernández-Díaz M José, Rodríguez-Sanjuán Juan Carlos, Manuel-Palazuelos José Carlos, de Diego García Ernesto Matias, Gómez-Fleitas Manuel
Unidad de Cirugía Esófago-Gástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España.
Unidad de Cirugía Esófago-Gástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España.
Cir Esp. 2015 Jun-Jul;93(6):396-402. doi: 10.1016/j.ciresp.2015.01.002. Epub 2015 Mar 18.
There is scant experience with robot-assisted esophagectomy in cases of esophageal and gastro-esophageal junction cancer. Our aim is to report our current experience.
Observational cohort study of the first 32 patients who underwent minimally invasive esophagectomy for esophageal cancer from September 2011 to June 2014. The gastric tube was created laparoscopically. In the thoracic field, a robot-assisted thoracoscopic approach was performed in the prone position with intrathoracic robotic hand-sewn anastomosis. Patient and tumour characteristics, surgical technique, short-term outcomes (morbidity and mortality) and oncological results (radicality and number of removed nodes) were evaluated.
Thirty-two patients, with a mean age of 58 years (34-74) were treated by a totally minimally invasive esophagectomy: robotic laparoscopy and thoracoscopy (11 McKeown and 21 Ivor-Lewis). Twenty-nine received neoadjuvant chemoradiotherapy. There were no conversions to open surgery. Console time was 218minutes (190-285). Blood loss was 170ml (40-255). One patient died from cardiac disease. Nine patients had a major complication (Dindo-Clavien grade II or higher). There was no case of respiratory complication or recurrent laryngeal nerve palsy. Five patients had intrathoracic fistula, 4 radiological and one clinical. Three had chylothorax, 2 cervical fistula and one gastric tube necrosis. The median hospital stay was 12 days (8-50). All the resections were R0 and the median of removed lymph nodes was 16 (2-23).
Our results suggest that minimally invasive esophagectomy with robot-assisted thoracoscopy is safe and achieves oncological standards.
在食管癌和食管胃交界癌病例中，机器人辅助食管切除术的经验较少。我们的目的是报告我们目前的经验。
对2011年9月至2014年6月期间接受微创食管癌切除术的前32例患者进行观察性队列研究。胃管通过腹腔镜制作。在胸部手术中，采用机器人辅助胸腔镜方法，患者取俯卧位，在胸腔内行机器人手工缝合吻合术。评估患者和肿瘤特征、手术技术、短期结局（发病率和死亡率）以及肿瘤学结果（根治性和切除淋巴结数量）。
32例患者平均年龄58岁（34 - 74岁），接受了完全微创食管切除术：机器人腹腔镜和胸腔镜手术（11例麦克尤恩术式和21例艾弗 - 刘易斯术式）。29例患者接受了新辅助放化疗。无中转开腹手术病例。控制台操作时间为218分钟（190 - 285分钟）。失血量为170毫升（40 - 255毫升）。1例患者死于心脏病。9例患者发生严重并发症（根据迪诺 - 克莱维恩分级为II级或更高）。无呼吸并发症或喉返神经麻痹病例。5例患者发生胸内瘘，4例为影像学诊断，1例为临床诊断。3例发生乳糜胸，2例发生颈部瘘，1例发生胃管坏死。中位住院时间为12天（8 - 50天）。所有切除均为R0切除，切除淋巴结的中位数为16枚（2 - 23枚）。
我们的结果表明，机器人辅助胸腔镜微创食管切除术是安全的，并且达到了肿瘤学标准。
