Department of Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
Centre for Bioinformatics, University of Veterinary Medicine Budapest, Budapest, Hungary.
Eur J Cardiothorac Surg. 2021 Jun 14;59(6):1279-1285. doi: 10.1093/ejcts/ezaa473.
Robotic-assisted oesophagectomy for cancer has been increasingly employed worldwide; however, the benefits of this technique compared to conventional minimally invasive oesophagectomy are unclear. Since 2016, hybrid robotic minimally invasive oesophagectomy (R-HMIE) has increasingly replaced hybrid laparoscopic minimally invasive oesophagectomy (HMIE) as the standard of care in our institution. The aim of this study was to compare these procedures.
Over a 10-year period, 686 patients underwent oesophagectomy at our institution. Out of these patients, 128 patients with cancer were treated with a hybrid minimally invasive technique. Each patient who underwent R-HMIE was matched according to gender, age, comorbidity, American Society of Anesthesiologists classification, Union International Contre le Cancer stage, localization, histology and neoadjuvant treatment with a patient who underwent HMIE. Perioperative parameters were extracted from our database and compared between the 2 groups.
After the matching procedure, 88 patients were included in the study. Between HMIE and R-HMIE, no significant differences (P > 0.05) were found in operating time (median 281 vs 300 min), R0 resection rate (n = 42 vs 42), harvested lymph nodes (median 28 vs 24), hospital stay (median 19 vs 17 days) and intensive care unit stay (median 7 vs 6.5 days). Regarding surgical complications, no difference could be observed either (n = 42 vs 44).
Minimally invasive oesophagectomy remains a challenging operation with high morbidity even in a high-volume institution. According to our intra- and short-term results, we have found no difference between R-HMIE and HMIE.
机器人辅助食管癌根治术在全球范围内的应用日益增多；然而，与传统的微创食管癌根治术相比，其优势尚不清楚。自 2016 年以来，杂交机器人微创食管癌根治术（R-HMIE）在我院逐渐取代了杂交腹腔镜微创食管癌根治术（HMIE），成为治疗的标准。本研究旨在比较这两种手术方式。
在过去的 10 年中，我院共有 686 例患者接受了食管癌切除术。在这些患者中，128 例癌症患者采用了微创杂交技术进行治疗。对每例接受 R-HMIE 的患者，根据性别、年龄、合并症、美国麻醉医师协会分类、国际抗癌联盟分期、肿瘤位置、组织学和新辅助治疗情况，与接受 HMIE 的患者进行匹配。从我们的数据库中提取围手术期参数，并对两组进行比较。
经过匹配程序，共有 88 例患者纳入本研究。HMIE 和 R-HMIE 两组间手术时间（中位数 281 分钟比 300 分钟）、R0 切除率（n=42 比 42）、淋巴结清扫数目（中位数 28 个比 24 个）、住院时间（中位数 19 天比 17 天）和重症监护病房停留时间（中位数 7 天比 6.5 天）无显著差异（P>0.05）。手术并发症方面，两组间也无差异（n=42 比 44）。
即使在高容量的机构中，微创食管癌根治术仍然是一种具有高发病率的挑战性手术。根据我们的长期和短期结果，我们发现 R-HMIE 和 HMIE 之间没有差异。
