Chao Yin-Kai, Hsieh Ming-Ju, Liu Yun-Hen, Liu Hui-Ping
Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, No 5. Fu-Hsing Street, Taoyuan, Taiwan.
World J Surg. 2018 Feb;42(2):590-598. doi: 10.1007/s00268-017-4179-0.
Radical lymph node dissection (LND) along the bilateral recurrent laryngeal nerve (RLN) is a surgically challenging procedure with a high rate of morbidity. Here, we assessed in a retrospective manner the adequacy of LND along the RLN performed with robot-assisted thoracoscopic esophagectomy (RATE) versus video-assisted thoracoscopic esophagectomy (VATE) in patients with esophageal squamous cell carcinoma (ESCC).
This was a single-center, retrospective, propensity-matched study. ESCC patients who underwent McKeown esophagectomy and bilateral RLN LND with a minimally invasive approach were divided into two groups according to the use of robot-assisted surgery or not (RATE vs VATE, respectively). Using propensity score matching, 34 balanced matched pairs were identified. The number of dissected nodes as well as the rates of RLN palsy and perioperative complications served as the main outcome measures.
No conversion to open thoracotomy occurred in either group. Intraoperative blood loss and the need of blood transfusions did not show significant intergroup differences. The mean number of dissected nodes was similar in the two study groups, the only exception being the left RLN area. Specifically, the mean number of nodes removed from this region was 5.32 in the RATE group and 3.38 in patients who received VATE (p = 0.007). Notably, the RATE and VATE groups did not differ significantly with regard to rates of both RLN palsy (20.6 vs 29.4%, respectively, p = 0.401) and pulmonary complications (5.9 vs 17.6%, respectively, p = 0.259).
Compared with VATE, RATE resulted in a higher lymph node yield along the left RLN without increasing morbidity.
沿双侧喉返神经（RLN）进行根治性淋巴结清扫术（LND）是一项具有高发病率的外科挑战性手术。在此，我们以回顾性方式评估了在食管鳞状细胞癌（ESCC）患者中，机器人辅助胸腔镜食管切除术（RATE）与电视辅助胸腔镜食管切除术（VATE）进行沿RLN的LND的充分性。
这是一项单中心、回顾性、倾向匹配研究。采用微创方法接受麦克基翁食管切除术和双侧RLN LND的ESCC患者根据是否使用机器人辅助手术分为两组（分别为RATE组和VATE组）。使用倾向评分匹配，确定了34对平衡匹配对。清扫淋巴结的数量以及RLN麻痹和围手术期并发症的发生率作为主要结局指标。
两组均未发生转为开胸手术的情况。术中失血量和输血需求在组间未显示出显著差异。两个研究组清扫淋巴结的平均数量相似，唯一的例外是左RLN区域。具体而言，RATE组从该区域切除的淋巴结平均数量为5.32个，接受VATE的患者为3.38个（p = 0.007）。值得注意的是，RATE组和VATE组在RLN麻痹率（分别为20.6%和29.4%，p = 0.401）和肺部并发症率（分别为5.9%和17.6%，p = 0.259）方面均无显著差异。
与VATE相比，RATE在不增加发病率的情况下，使左RLN沿线的淋巴结收获量更高。
