Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Bariatric & Metabolic Care, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Surg Endosc. 2020 Apr;34(4):1602-1611. doi: 10.1007/s00464-019-06923-7. Epub 2019 Jul 8.
The good short-term and oncological outcomes of robot-assisted radical esophagectomy have been demonstrated, although its impact on long-term health-related quality of life (HRQoL) remains to be investigated. This study aimed to assess long-term HRQoL in patients after robot-assisted radical transmediastinal esophagectomy (TME), which is characterized as non-transthoracic esophagectomy comprising a robotic transhiatal approach and a video-assisted cervical approach, and transthoracic esophagectomy (TTE).
The European Organization for Research and Treatment of Cancer generic and disease-specific modules (QLQ-C30 and QLQ-OES18), nutritional status and body composition data were prospectively collected in patients undergoing TME or TTE before and at 3, 6, 12, 18, and 24 months after surgery. The results of long-term (≥ 2 years) survivors without recurrence were compared between the two groups.
A total of 37 patients (TME; n = 18, TTE; n = 19) were included for analysis. Longitudinal survey of function scales revealed scores of physical, role, social, and emotional function to be significantly better in the TME group than in the TTE group at many points postoperatively. Markedly, the symptoms of general pain, esophageal pain, and dry mouth greatly worsened after surgery in the TTE group, but did not deteriorate in the TME group. In contrast, symptoms relating to eating difficulties, body composition data, and nutritional status did not differ between the groups over time. At 24 months after surgery, TME provided significantly higher scores of global QOL (P = 0.01) and emotional function (P = 0.01) and also resulted in significantly fewer problems of fatigue (P = 0.04), general pain (P = 0.04), insomnia (P = 0.02), and dry mouth (P = 0.03), as compared to TTE.
This study indicates that TME can provide better long-term HRQoL outcomes than TTE.
机器人辅助根治性食管切除术具有良好的短期和肿瘤学结果，但其对长期健康相关生活质量（HRQoL）的影响仍有待研究。本研究旨在评估机器人辅助经纵隔根治性食管切除术（TME）后患者的长期 HRQoL，其特点是非经胸食管切除术，包括机器人经食管裂孔入路和视频辅助颈部入路以及经胸食管切除术（TTE）。
在手术前和手术后 3、6、12、18 和 24 个月，前瞻性地收集接受 TME 或 TTE 的患者的欧洲癌症研究与治疗组织通用和疾病特异性模块（QLQ-C30 和 QLQ-OES18）、营养状况和身体成分数据。将两组无复发的长期（≥2 年）幸存者的结果进行比较。
共有 37 名患者（TME；n=18，TTE；n=19）纳入分析。功能量表的纵向调查显示，在许多术后点，TME 组的身体、角色、社会和情感功能评分明显优于 TTE 组。值得注意的是，TTE 组手术后一般疼痛、食管疼痛和口干症状明显恶化，但 TME 组没有恶化。相比之下，两组在时间上在进食困难、身体成分数据和营养状况方面没有差异。手术后 24 个月，TME 提供了更高的全球 QOL 评分（P=0.01）和情绪功能评分（P=0.01），并且还导致疲劳（P=0.04）、一般疼痛（P=0.04）、失眠（P=0.02）和口干（P=0.03）的问题明显减少，与 TTE 相比。
本研究表明，与 TTE 相比，TME 可以提供更好的长期 HRQoL 结果。
