Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, Ohio.
Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, Ohio.
J Surg Res. 2021 Apr;260:220-228. doi: 10.1016/j.jss.2020.11.077. Epub 2020 Dec 23.
Robotic esophagectomies are increasingly common and are reported to have superior outcomes compared with an open approach; however, it is unclear if all institutions can achieve such outcomes. We hypothesize that early adopters of robotic technique would have improved short-term outcomes.
The National Cancer Database (2010-2016) was used to identify robotic esophagectomies. Early adopters were defined as programs which performed robotic esophagectomies in 2010-2011, late adopters in 2012-2013. Outcomes of esophagectomies performed between 2014 and 2016 were compared and included length of stay, number of lymph nodes evaluated, readmission, conversion rate, and 90-day mortality. Multivariable regressions, accounting for robotic esophagectomy volume, were used to control for confounding factors.
There were 37 early adopters and 35 late adopters. Between 2014 and 2016, 683 robotic esophagectomies were performed: 446 (65.3%) by early adopters and 237 (34.7%) by late adopters. Early adopters were more likely to be academic programs (96.2 versus 72.8%, P < 0.01). Other clinical and demographic variables were similar. Late adopters were found to have decreased a number of lymph nodes evaluated (coefficient -2.407, P = 0.004) compared with early adopters. There were no significant differences in length of stay, readmissions, rate of positive margins, conversion from robotic to open, or 90-day mortality.
When accounting for robotic esophagectomy volume, late adoption of robotic esophagectomy was associated with a reduced lymph node harvest, but other postoperative outcomes were similar. These data suggest that programs can safely start new robotic esophagectomy programs, but must ensure an adequate case load.
机器人食管切除术越来越常见，与开放手术相比，其报告结果更优；然而，目前尚不清楚所有机构是否都能达到这样的结果。我们假设机器人技术的早期采用者会有更好的短期结果。
国家癌症数据库（2010-2016 年）用于识别机器人食管切除术。早期采用者被定义为在 2010-2011 年开展机器人食管切除术的项目，晚期采用者为在 2012-2013 年开展机器人食管切除术的项目。比较了 2014 年至 2016 年期间进行的食管切除术的结果，包括住院时间、评估的淋巴结数量、再入院、转化率和 90 天死亡率。使用多变量回归，考虑到机器人食管切除术的数量，控制混杂因素。
有 37 个早期采用者和 35 个晚期采用者。2014 年至 2016 年期间，共进行了 683 例机器人食管切除术：446 例（65.3%）由早期采用者进行，237 例（34.7%）由晚期采用者进行。早期采用者更有可能是学术项目（96.2%比 72.8%，P<0.01）。其他临床和人口统计学变量相似。与早期采用者相比，晚期采用者评估的淋巴结数量减少（系数-2.407，P=0.004）。住院时间、再入院率、阳性切缘率、从机器人转为开放手术的比例或 90 天死亡率均无显著差异。
当考虑机器人食管切除术的数量时，机器人食管切除术的晚期采用与淋巴结清扫减少有关，但其他术后结果相似。这些数据表明，项目可以安全地开展新的机器人食管切除术，但必须确保足够的病例量。
