Department of Cardiothoracic Surgery, Jingling Hospital, Jingling School of Clinical Medicine, Nanjing Medical University, Nanjing, China.
Department of Cardiothoracic Surgery, Jingling Hospital, School of Medicine, Southeast University, Nanjing, China.
Dis Esophagus. 2021 Sep 9;34(9). doi: 10.1093/dote/doaa114.
The long-term outcomes of robotic-assisted McKeown esophagectomy (RAME) compared to thoraco-laparoscopic McKeown esophagectomy (TLME) for the patients with esophageal squamous cell carcinoma (ESCC) remain unclear. The aim of this study was to compare the number of dissected lymph nodes and long-term survival between RAME and TLME using a propensity score-matched (PSM) analysis. A total of 721 patients undergoing minimally invasive McKeown esophagectomy at our department from February 2015 to October 2019 were analyzed, including 310 patients in RAME group and 411 in TLME group. The exact numbers of lymph nodes including those among thoracic and abdominal categories as well as those along the recurrent laryngeal nerve (RLN) were all recorded. PSM analysis was applied to generate matched pairs for further comparison. All patients with R0 resection were followed with a strict follow-up period which range from 1 to 56 months. The effect of lymphadenectomy was compared between all patients in unmatched and matched groups. Long-term outcomes consisting of overall survival (OS), disease-free survival (DFS) and recurrence rate (including regional recurrence rate, systemic recurrence rate and mediastinal lymph nodes recurrence rate) were compared in R0 resection patients. Finally, 292 patients were identified for each cohort after PSM. RAME was found to yield significantly more left RLN lymph nodes (mean: 2.27 ± 0.90 vs. 2.09 ± 0.79; P = 0.011) and more thoracic lymph nodes (mean: 12.60 ± 4.22 vs. 11.83 ± 3.12, P = 0.012) compared with TLME after PSM analysis. There was no significant difference in the OS and DFS between the RAME and TLME group. Besides, total recurrences were recognized in 33 (11.7%) patients in the RAME group and 36 (12.9%) in the TLME group (P = 0.676). The mediastinal lymph nodes recurrence rate in the RAME group was tended to be lower than that in the TLME group (2.5% vs. 5.4%, P = 0.079). Therefore, RAME might be an alternative approach for the treatment of ESCC with more lymph nodes dissected and similar long-term survival outcomes compared to TLME.
机器人辅助 McKeown 食管切除术（RAME）与胸腔镜辅助 McKeown 食管切除术（TLME）治疗食管鳞状细胞癌（ESCC）患者的长期结果尚不清楚。本研究旨在通过倾向评分匹配（PSM）分析比较 RAME 和 TLME 之间的淋巴结清扫数量和长期生存。2015 年 2 月至 2019 年 10 月，我科对 721 例接受微创 McKeown 食管切除术的患者进行了分析，其中 RAME 组 310 例，TLME 组 411 例。记录了包括胸、腹分类在内的淋巴结总数以及沿喉返神经（RLN）的淋巴结总数。应用 PSM 分析生成匹配对以进一步比较。所有 R0 切除的患者均进行了严格的随访，随访时间为 1 至 56 个月。比较了未匹配和匹配组中所有患者的淋巴结清扫效果。在 R0 切除患者中比较了总生存（OS）、无病生存（DFS）和复发率（包括局部复发率、全身复发率和纵隔淋巴结复发率）等长期结果。最后，PSM 后每个队列确定了 292 例患者。PSM 分析显示，RAME 组左侧 RLN 淋巴结（平均：2.27±0.90 比 2.09±0.79；P=0.011）和胸内淋巴结（平均：12.60±4.22 比 11.83±3.12；P=0.012）明显多于 TLME 组。PSM 分析后，RAME 组与 TLME 组的 OS 和 DFS 无显著差异。此外，RAME 组 33 例（11.7%）和 TLME 组 36 例（12.9%）患者出现总复发（P=0.676）。RAME 组纵隔淋巴结复发率低于 TLME 组（2.5%比 5.4%，P=0.079）。因此，与 TLME 相比，RAME 可能是一种治疗 ESCC 的替代方法，可切除更多的淋巴结，且长期生存结果相似。
