Esagian Stepan M, Ziogas Ioannis A, Skarentzos Konstantinos, Katsaros Ioannis, Tsoulfas Georgios, Molena Daniela, Karamouzis Michalis V, Rouvelas Ioannis, Nilsson Magnus, Schizas Dimitrios
Surgery Working Group, Society of Junior Doctors, 151-23 Athens, Greece.
First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 115-27 Athens, Greece.
Cancers (Basel). 2022 Jun 29;14(13):3177. doi: 10.3390/cancers14133177.
Robot-assisted minimally invasive esophagectomy (RAMIE) was introduced as a further development of the conventional minimally invasive esophagectomy, aiming to further improve the high morbidity and mortality associated with open esophagectomy. We aimed to compare the outcomes between RAMIE and open esophagectomy, which remains a popular approach for resectable esophageal cancer. Ten studies meeting our inclusion criteria were identified, including five retrospective cohort, four prospective cohort, and one randomized controlled trial. RAMIE was associated with significantly lower rates of overall pulmonary complications (odds ratio (OR): 0.38, 95% confidence interval (CI): [0.26, 0.56]), pneumonia (OR: 0.39, 95% CI: [0.26, 0.57]), atrial fibrillation (OR: 0.53, 95% CI: [0.29, 0.98]), and wound infections (OR: 0.20, 95% CI: [0.07, 0.57]) and resulted in less blood loss (weighted mean difference (WMD): -187.08 mL, 95% CI: [-283.81, -90.35]) and shorter hospital stays (WMD: -9.22 days, 95% CI: [-14.39, -4.06]) but longer operative times (WMD: 69.45 min, 95% CI: [34.39, 104.42]). No other statistically significant difference was observed regarding surgical and short-term oncological outcomes. Similar findings were observed when comparing totally robotic procedures only to OE. RAMIE is a safe and feasible procedure, resulting in decreased cardiopulmonary morbidity, wound infections, blood loss, and shorter hospital stays compared to open esophagectomy.
机器人辅助微创食管切除术（RAMIE）是作为传统微创食管切除术的进一步发展而引入的，旨在进一步改善与开放性食管切除术相关的高发病率和死亡率。我们旨在比较RAMIE与开放性食管切除术的结果，开放性食管切除术仍是可切除食管癌的常用方法。我们确定了10项符合纳入标准的研究，包括5项回顾性队列研究、4项前瞻性队列研究和1项随机对照试验。RAMIE的总体肺部并发症发生率（优势比（OR）：0.38，95%置信区间（CI）：[0.26，0.56]）、肺炎发生率（OR：0.39，95%CI：[0.26，0.57]）、心房颤动发生率（OR：0.53，95%CI：[0.29，0.98]）和伤口感染发生率（OR：0.20，95%CI：[0.07，0.57]）显著更低，且失血更少（加权平均差（WMD）：-187.08 mL，95%CI：[-283.81，-90.35]），住院时间更短（WMD：-9.22天，95%CI：[-14.39，-4.06]），但手术时间更长（WMD：69.45分钟，95%CI：[34.39，104.42]）。在手术和短期肿瘤学结果方面未观察到其他统计学上的显著差异。仅将全机器人手术与开放性食管切除术进行比较时，也观察到了类似的结果。与开放性食管切除术相比，RAMIE是一种安全可行的手术，可降低心肺发病率、伤口感染、失血量，并缩短住院时间。
