Mehdorn Anne-Sophie, Möller Thorben, Franke Frederike, Richter Florian, Kersebaum Jan-Niclas, Becker Thomas, Egberts Jan-Hendrik
Department of General, Abdominal, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
J Clin Med. 2020 Oct 30;9(11):3513. doi: 10.3390/jcm9113513.
Esophagectomies are among the most invasive surgical procedures that highly influence health-related quality of life (HRQoL). Recent improvements have helped to achieve longer survival. Therefore, long-term postoperative HRQoL needs to be emphasized in addition to classic criterions like morbidity and mortality. We aimed to compare short and long-term HRQoL after open transthoracic esophagectomies (OTEs) and robotic-assisted minimally invasive esophagectomies (RAMIEs) in patients suffering from esophageal adenocarcinoma. Prospectively collected HRQoL-data (from the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire-C30 (EORTC QLQ-C30)) were correlated with clinical courses. Only patients suffering from minor postoperative complications (Clavien-Dindo Classification of < 2) after R0 Ivor-Lewis-procedures were included. Age, sex, body mass index (BMI), American Society of Anesthesiologists physical status-score (ASA-score), tumor stage, and perioperative therapy were used for propensity score matching (PSM). Twelve RAMIE and 29 OTE patients met the inclusion criteria. RAMIE patients reported significantly better emotional and social function while suffering from significantly less pain and less physical impairment four months after surgery. The long-term follow up confirmed the results. Long-term postoperative HRQoL and self-perception partly exceeded the levels of the healthy reference population. Minor operative trauma by robotic approaches resulted in significantly reduced physical impairments while improving HRQoL and self-perception, especially in the long-term. However, further long-term results are warranted to confirm this positive trend.
食管切除术是最具侵入性的外科手术之一，对健康相关生活质量（HRQoL）有很大影响。最近的进展有助于实现更长的生存期。因此，除了发病率和死亡率等经典标准外，还需要强调术后长期的HRQoL。我们旨在比较开放性经胸食管切除术（OTE）和机器人辅助微创食管切除术（RAMIE）治疗食管腺癌患者后的短期和长期HRQoL。前瞻性收集的HRQoL数据（来自欧洲癌症研究与治疗组织核心生活质量问卷-C30（EORTC QLQ-C30））与临床病程相关。仅纳入在R0 Ivor-Lewis手术术后出现轻微并发症（Clavien-Dindo分级<2）的患者。使用年龄、性别、体重指数（BMI）、美国麻醉医师协会身体状况评分（ASA评分）、肿瘤分期和围手术期治疗进行倾向评分匹配（PSM）。12例RAMIE患者和29例OTE患者符合纳入标准。RAMIE患者在术后四个月时报告情绪和社会功能明显更好，同时疼痛和身体损伤明显更少。长期随访证实了这些结果。术后长期的HRQoL和自我认知部分超过了健康对照人群的水平。机器人手术方法造成的手术创伤较小，导致身体损伤明显减少，同时改善了HRQoL和自我认知，尤其是在长期。然而，需要进一步的长期结果来证实这一积极趋势。
