Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
J Robot Surg. 2022 Aug;16(4):841-848. doi: 10.1007/s11701-021-01298-1. Epub 2021 Sep 20.
We aimed to compare the short- and long-term outcomes between robotic esophagectomy (RE) and open esophagectomy (OE) in patients with esophageal squamous cell carcinoma (ESCC). Among the patients who underwent esophagectomy for ESCC from 2008 to 2017, 402 patients (n = 178 in RE and n = 224 in OE) were enrolled and, after propensity-score matching, 136 patients in each group were selected. The total rate of complications was comparable, whereas the rate of major complications was higher in OE (p < 0.01). Hospital stay was longer in OE (15 days in OE vs. 13 days in RE; p = 0.03) with a comparable early mortality rate. Complete resection was equally achieved in both groups (96.3% in RE vs. 97.0% in OE; p = 0.74). The numbers of retrieved lymph nodes (LN) were significantly higher in RE (42.8 in RE vs 35.3 in OE; p < 0.01), especially for LNs in the left lower cervical paratracheal, both recurrent laryngeal nerves, and paraesophageal area. The 5-year overall survival rate was higher in RE (75.1% in RE vs. 57.9% in OE; p = 0.02), whereas, the freedom from recurrence was comparable between the two groups (68.8% in RE vs. 54.7% in OE; p = 0.15). Notably, RE achieved a significantly higher rate of 5-year freedom from regional nodal recurrence than OE (81.4% in RE vs. 62.7% in OE, p = 0.03). RE contributed to a lower rate of major complications and shorter hospital stays. Furthermore, RE showed increased long-term overall survival and freedom from regional LN recurrence rates, with a higher yield of LN dissection compared to OE.
我们旨在比较机器人食管切除术（RE）和开放食管切除术（OE）治疗食管鳞状细胞癌（ESCC）患者的短期和长期结果。在 2008 年至 2017 年间接受 ESCC 食管切除术的患者中，纳入 402 例患者（RE 组 178 例，OE 组 224 例），并进行倾向评分匹配后，每组各选择 136 例患者。总的并发症发生率相当，而 OE 组的主要并发症发生率更高（p<0.01）。OE 组的住院时间更长（15 天 vs. RE 组 13 天；p=0.03），早期死亡率相当。两组均达到了完全切除（RE 组 96.3% vs. OE 组 97.0%；p=0.74）。RE 组的淋巴结（LN）检出数明显高于 OE 组（RE 组 42.8 个 vs. OE 组 35.3 个；p<0.01），尤其是左颈下段气管旁、双侧喉返神经和食管旁区域的 LN。RE 组的 5 年总生存率更高（RE 组 75.1% vs. OE 组 57.9%；p=0.02），而两组的无复发生存率相当（RE 组 68.8% vs. OE 组 54.7%；p=0.15）。值得注意的是，RE 组 5 年区域淋巴结无复发生存率显著高于 OE 组（RE 组 81.4% vs. OE 组 62.7%；p=0.03）。RE 可降低主要并发症发生率和缩短住院时间。此外，RE 与 OE 相比，可提高长期总生存率和区域 LN 无复发生存率，并增加 LN 清扫量。
