Gong Lei, Jiang Hongjing, Yue Jie, Duan Xiaofeng, Tang Peng, Ren Peng, Zhao Xijiang, Liu Xiangming, Zhang Xi, Yu Zhentao
Department of Esophageal Cancer, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.
School and Hospital of Stomatology, Tianjin Medical University, Tianjin 300070, China.
J Thorac Dis. 2020 Mar;12(3):916-924. doi: 10.21037/jtd.2019.12.56.
The development of minimally invasive surgery has initiated many changes in the surgical treatment of esophageal cancer (EC) patients. The aim of this study was to compare the short-term outcomes of robotic-assisted minimally invasive esophagectomy (RAMIE), video-assisted minimally invasive esophagectomy (VAMIE), and open esophagectomy (OE).
Our study included patients who had undergone McKeown esophagectomy at Tianjin Medical University Cancer Institute and Hospital between January 2016 and December 2018. We analyzed clinical baseline data, as well as perioperative and pathological outcomes.
A total of 312 cases met the inclusion criteria (OE: 77, VAMIE: 144, RAMIE: 91). The OE group had a greater number of late-stage patients as well as those who received the neo-adjuvant therapy, compared with the other two groups (P=0.001). The procedure time in the OE group was also shorter by approximately 20 minutes (P=0.021). Total blood loss was significantly lower in the two MIE groups (P=0.004) than in the OE group. There were no differences in the total number of dissected lymph nodes between the three groups (OE: 24.09±10.77, VAMIE: 23.07±10.18, RAMIE: 22.84±8.37, P=0.680). Both the lymph node number (P=0.155) and achievement rate (P=0.190) in the right recurrent laryngeal nerve (RLN) area were comparable between the three groups. However, in the left RLN area, minimally invasive approaches resulted in a higher number of harvested lymph nodes (P=0.032) and greater achievement rate (P=0.018). Neither MIE procedure increased the incidence of postoperative complications.
Minimally invasive surgery could guarantee the quality of bilateral RLN lymphadenectomy without increasing postoperative complications, especially in RAMIE patients. The rational choice of different surgical approaches would improve both safety and oncological outcomes for patients.
微创手术的发展给食管癌（EC）患者的外科治疗带来了诸多变化。本研究旨在比较机器人辅助微创食管切除术（RAMIE）、电视辅助微创食管切除术（VAMIE）和开放食管切除术（OE）的短期疗效。
我们的研究纳入了2016年1月至2018年12月期间在天津医科大学肿瘤医院接受麦克尤恩食管切除术的患者。我们分析了临床基线数据以及围手术期和病理结果。
共有312例患者符合纳入标准（OE组：77例，VAMIE组：144例，RAMIE组：91例）。与其他两组相比，OE组晚期患者以及接受新辅助治疗的患者数量更多（P = 0.001）。OE组的手术时间也短约20分钟（P = 0.021）。两个微创食管切除术组的总失血量明显低于OE组（P = 0.004）。三组之间的清扫淋巴结总数无差异（OE组：24.09±10.77，VAMIE组：23.07±10.18，RAMIE组：22.84±8.37，P = 0.680）。三组在右侧喉返神经（RLN）区域的淋巴结数量（P = 0.155）和清扫成功率（P = 0.190）相当。然而，在左侧RLN区域，微创方法导致获取的淋巴结数量更多（P = 0.032）且清扫成功率更高（P = 0.018）。两种微创食管切除术均未增加术后并发症的发生率。
微创手术能够保证双侧RLN淋巴结清扫的质量，且不增加术后并发症，尤其是对于RAMIE患者。合理选择不同的手术方式可提高患者的安全性和肿瘤学疗效。
