Department of Surgery, University of Michigan, Ann Arbor, Michigan.
Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan.
Ann Thorac Surg. 2022 Feb;113(2):399-405. doi: 10.1016/j.athoracsur.2021.03.018. Epub 2021 Mar 18.
Patient-reported outcomes (PROs) for minimally invasive esophagectomy (MIE) have demonstrated benefits compared with open transthoracic or 3-hole esophagectomy. PROs, including quality of life (QoL) and fear of recurrence (FoR), comparing open transhiatal esophagectomy (THE) and transhiatal robotic-assisted MIE (Th-RAMIE) have been limited.
At a single, high-volume academic center, patients undergoing THE and Th-RAMIE with gastric conduit for clinical stage I to III esophageal cancer from 2013 to 2018 were evaluated. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30), the EORTC Quality of Life Questionnaire in Esophageal Cancer (QLQ-OES18), and the FoR survey were administered preoperatively and at 1, 6, and 12 months postoperatively. Linear mixed-effects models were used for QoL and FoR score comparisons. Perioperative outcomes were also compared.
A total of 309 patients (212 in the group and 97 in the Th-RAMIE group) were included. The Th-RAMIE cohort had a significantly higher number of lymph nodes harvested (14 ± 0.8 vs 11.2 ± 0.4; P = .01), a shorter length of stay (days, 10.0 ± 6.7 vs 12.1 ± 7.0; P = .03), lower rates of postoperative ileus (5% vs 15%; P = .02), and fewer opioids prescribed at discharge (71% vs 85%; P = .03). After adjustment, there were no significant differences in QLQ-C30, QLQ-OES18, and FoR scores between the groups out to 1 year postoperatively.
There were no clear patient-reported benefits of Th-RAMIE over THE for esophageal cancer. However, Th-RAMIE conferred several perioperative benefits.
微创食管切除术（MIE）的患者报告结果（PROs）与开胸或三孔食管切除术相比具有优势。然而，比较开胸经食管裂孔切除术（THE）和经食管裂孔机器人辅助 MIE（Th-RAMIE）的 PROs，包括生活质量（QoL）和复发恐惧（FoR），其研究结果较为有限。
在一家单一的、高容量的学术中心，从 2013 年到 2018 年，对接受 THE 和 Th-RAMIE 治疗且使用胃管的临床 I 至 III 期食管癌患者进行了评估。在术前以及术后 1、6 和 12 个月时，患者填写欧洲癌症研究与治疗组织（EORTC）生活质量问卷（QLQ-C30）、EORTC 食管癌生活质量问卷（QLQ-OES18）和 FoR 调查。采用线性混合效应模型比较 QoL 和 FoR 评分。还比较了围手术期结局。
共纳入 309 例患者（212 例在 THE 组，97 例在 Th-RAMIE 组）。Th-RAMIE 组的淋巴结清扫数量明显更多（14 ± 0.8 比 11.2 ± 0.4；P =.01），住院时间更短（天数，10.0 ± 6.7 比 12.1 ± 7.0；P =.03），术后肠梗阻发生率更低（5%比 15%；P =.02），出院时开具的阿片类药物更少（71%比 85%；P =.03）。调整后，两组患者在术后 1 年时的 QLQ-C30、QLQ-OES18 和 FoR 评分均无显著差异。
Th-RAMIE 与 THE 相比，在食管癌患者中没有明显的患者报告获益。然而，Th-RAMIE 带来了一些围手术期的优势。
