Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Ann Surg Oncol. 2019 May;26(5):1284-1291. doi: 10.1245/s10434-019-07273-3. Epub 2019 Mar 6.
Both robot-assisted Ivor Lewis esophagectomy (RAILE) and conventional thoracoscopic-assisted Ivor Lewis esophagectomy (TAILE) are minimally invasive surgical techniques for the treatment of middle and distal esophageal cancer. However, no research studies comparing early outcomes between RAILE and TAILE have been reported.
A retrospective analysis was made of 184 patients, 76 in the RAILE group and 108 in the TAILE group, who underwent minimally invasive Ivor Lewis esophagectomy between December 2014 and June 2018. Propensity score-matched analysis was performed between the two groups based on demographics, comorbidities, American Society of Anesthesiologists score, tumor location, tumor size, and pathological stage. Perioperative outcomes were compared.
Two conversions to thoracotomy occurred in the RAILE group. There was no 30-day in either group. Sixty-six matched pairs were identified for each group. Within the propensity score-matched cohorts, the operative time in the RAILE group was significantly longer than that in the TAILE group (302.0 ± 62.9 vs. 274.7 ± 38.0 min, P = 0.004). There was no significant difference in the blood loss [200.0 ml (interquartile range [IQR], 100.0-262.5 ml) vs. 200.0 ml (150.0-245.0 ml), P = 0.100], rates of overall complications (28.8 vs. 24.2%, P = 0.554), length of stay [9.0 days (IQR 8.0-12.3 days) vs. 9.0 days (IQR 8.0-11.3 days), P = 0.517], the number of total dissected lymph nodes (19.2 ± 9.2 vs. 19.3 ± 9.5, P = 0.955), and detailed categories of lymph nodes.
RAILE demonstrated comparable early outcomes compared with TAILE and should be considered as an alternative minimally invasive option for treating esophageal cancer.
机器人辅助 Ivor Lewis 食管切除术（RAILE）和传统胸腔镜辅助 Ivor Lewis 食管切除术（TAILE）均为治疗中下段食管癌的微创手术。然而，目前尚未有研究比较 RAILE 和 TAILE 的早期结果。
回顾性分析了 2014 年 12 月至 2018 年 6 月间接受微创 Ivor Lewis 食管切除术的 184 例患者，其中 RAILE 组 76 例，TAILE 组 108 例。根据人口统计学、合并症、美国麻醉医师协会评分、肿瘤位置、肿瘤大小和病理分期，对两组进行倾向评分匹配分析。比较围手术期结果。
RAILE 组有 2 例中转开胸。两组均无 30 天内死亡病例。每组各匹配 66 对。在倾向评分匹配队列中，RAILE 组的手术时间明显长于 TAILE 组（302.0±62.9 分钟 vs. 274.7±38.0 分钟，P=0.004）。两组术中出血量[200.0 ml（四分位距 [IQR]，100.0-262.5 ml）vs. 200.0 ml（IQR，150.0-245.0 ml），P=0.100]、总体并发症发生率（28.8% vs. 24.2%，P=0.554）、住院时间[9.0 天（IQR，8.0-12.3 天）vs. 9.0 天（IQR，8.0-11.3 天），P=0.517]、总清扫淋巴结数（19.2±9.2 枚 vs. 19.3±9.5 枚，P=0.955）及详细淋巴结分类无显著差异。
RAILE 与 TAILE 相比具有相当的早期结果，应被视为治疗食管癌的另一种微创选择。
