Na Kwon Joong, Park Samina, Park In Kyu, Kim Young Tae, Kang Chang Hyun
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
J Thorac Dis. 2019 Dec;11(12):5310-5320. doi: 10.21037/jtd.2019.11.58.
Robot-assisted minimally invasive esophagectomy (RAMIE) reduces postoperative respiratory complications and enables meticulous mediastinal lymphadenectomy. However, whether adding a robotic abdominal procedure to a robotic thoracic procedure can result in better outcomes is unclear. We examined outcomes after total-RAMIE (T-RAMIE) and compared them with the outcomes after hybrid-RAMIE (H-RAMIE).
Total of 227 patients who underwent robotic esophagectomy for esophageal cancer were included. T-RAMIE was defined as esophagectomy performed robotically in both the thoracic and abdominal cavities. Laparotomy was used instead of the robotic procedure in H-RAMIE. T-RAMIE was performed in 144 patients (63.4%), and propensity score matching produced 49 matched pairs from each group. Early and long-term clinical outcomes between the two groups were compared.
T-RAMIE was mostly performed for upper or mid-thoracic squamous cell carcinoma (n=119, 82.6%) and cervical anastomosis, and three-field lymphadenectomy was performed in 113 (78.5%) and 54 (37.5%) patients, respectively. One laparotomy conversion was necessary because of severe obesity. The propensity-matched analysis demonstrated that T-RAMIE showed a comparable 90-day mortality rate with H-RAMIE (0% . 6.1%, P=0.083). The incidence rates of total (63.3% . 63.3%; P=1.000), abdominal (8.2% . 14.3%; P=0.366), and respiratory complications (10.2% . 10.2%; P=1.000) were not different between two groups. The number of harvested abdominal lymph nodes was similar (12.4±9.0 . 12.3±8.9; P=0.992). Median follow-up duration for T-RAMIE and H-RAMIE was 16.3 and 23.5 months, respectively. Two-year overall survival rate (86.2% in T-RAMIE 77.6% in H-RAMIE; P=0.150) and recurrence-free survival (76.6% in T-RAMIE . 62.2% in H-RAMIE; P=0.280) were comparable between the two groups.
In this matched analysis, T-RAMIE and H-RAMIE showed comparable early outcomes and long-term survival. The low tendencies of early mortality and conversion rate of T-RAMIE suggest that it might be a safe alternative to open stomach mobilization and abdominal lymphadenectomy.
机器人辅助微创食管切除术（RAMIE）可减少术后呼吸并发症，并能进行细致的纵隔淋巴结清扫。然而，在机器人胸腔手术基础上增加机器人腹部手术是否能带来更好的结果尚不清楚。我们研究了全机器人辅助微创食管切除术（T-RAMIE）后的结果，并将其与杂交机器人辅助微创食管切除术（H-RAMIE）后的结果进行比较。
纳入227例行机器人食管癌切除术的患者。T-RAMIE定义为在胸腔和腹腔均通过机器人进行的食管切除术。H-RAMIE中采用开腹手术替代机器人手术。144例患者（63.4%）接受了T-RAMIE，倾向评分匹配后每组产生49对匹配病例。比较两组的早期和长期临床结果。
T-RAMIE主要用于治疗胸上段或中段鳞状细胞癌（n = 119，82.6%）并进行颈部吻合，分别有113例（78.5%）和54例（37.5%）患者进行了三野淋巴结清扫。因严重肥胖，有1例需要转为开腹手术。倾向评分匹配分析显示，T-RAMIE与H-RAMIE的90天死亡率相当（0%对6.1%，P = 0.083）。两组的总并发症发生率（63.3%对63.3%；P = 1.000）、腹部并发症发生率（8.2%对14.3%；P = 0.366）和呼吸并发症发生率（10.2%对10.2%；P = 1.000）无差异。获取的腹部淋巴结数量相似（12.4±9.0对12.3±8.9；P = 0.992）。T-RAMIE和H-RAMIE的中位随访时间分别为16.3个月和23.5个月。两组的两年总生存率（T-RAMIE为86.2%，H-RAMIE为77.6%；P = 0.150）和无复发生存率（T-RAMIE为76.6%，H-RAMIE为62.2%；P = 0.280）相当。
在这项匹配分析中，T-RAMIE和H-RAMIE显示出相当的早期结果和长期生存率。T-RAMIE的早期死亡率和转换率较低，表明它可能是开放胃游离和腹部淋巴结清扫的安全替代方法。
