Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany.
Department of Data Sciences and Operations, Marshall School of Business, University of Southern California, Los Angeles, CA, USA.
Ann Surg Oncol. 2022 Nov;29(12):7498-7509. doi: 10.1245/s10434-022-12200-0. Epub 2022 Jul 19.
Robot-assisted minimally invasive esophagectomy (RAMIE) shows promising results regarding postoperative complications in patients with esophageal cancer. To date, no data are available regarding postoperative analgesic consumption. The aim of this work is to evaluate analgesic consumption after esophagectomy.
A total of 274 Ivor Lewis esophageal resections performed sequentially from January 2012 to December 2020 were evaluated. RAMIE cases (n = 51) were compared with the hybrid technique (laparoscopic abdominal phase followed by open thoracotomy, n = 59) and open abdominothoracic esophagectomy (OTE) (n = 164). Data were collected retrospectively. The primary endpoint was the overall postoperative morphine consumption, which represents a reliable indirect measurement of pain. Pain levels recorded on the first, third, and fifth postoperative days were assessed as secondary endpoints.
A total of 274 patients were included. The postoperative opioid consumption rate for patients who underwent RAMIE (quartiles: 0.14, 0.23, 0.36 mg morphine milligram equivalents (MME)/kg body weight (bw)/day) was significantly lower than in the open group (0.19, 0.33, 0.58 mg MME/kg bw/day, p = 0.016). The overall postoperative opioid consumption for patients who underwent RAMIE was significantly lower (2.45, 3.63, 7.20 mg MME/kg bw/day; morphine milligram equivalents per kilogram body weight) compared with the open (4.85, 8.59, 14.63 MME/kg bw/day, p < 0.0001) and hybrid (4.13, 6.84, 11.36 MME/kg bw/day, p = 0.008) groups. Patients who underwent RAMIE reported lower pain scores compared with the open group on the fifth postoperative day, both at rest (p = 0.004) and while performing activities (p < 0.001).
This study shows that patients who underwent RAMIE experienced similar postoperative pain while requiring significantly lower amounts of opioids compared with patients who underwent open and hybrid surgery. Further studies are required to verify the results.
机器人辅助微创食管切除术（RAMIE）在食管癌患者的术后并发症方面显示出良好的效果。迄今为止，尚无关于术后镇痛消耗的数据。本研究旨在评估食管切除术后的镇痛消耗。
评估了 2012 年 1 月至 2020 年 12 月期间连续进行的 274 例 Ivor Lewis 食管切除术。将 RAMIE 病例（n=51）与杂交技术（腹腔镜腹部阶段后行开胸手术，n=59）和开腹胸腹食管切除术（OTE）（n=164）进行比较。数据进行回顾性收集。主要终点是术后吗啡总消耗量，这是疼痛的可靠间接测量指标。次要终点是术后第 1、3 和 5 天记录的疼痛水平。
共纳入 274 例患者。RAMIE 组（四分位数：0.14、0.23、0.36mg 吗啡毫克当量（MME）/kg 体重（bw）/天）的术后阿片类药物消耗率明显低于开放组（0.19、0.33、0.58mg MME/kg bw/天，p=0.016）。RAMIE 组患者的术后阿片类药物总消耗量（2.45、3.63、7.20mg MME/kg bw/天；吗啡毫克当量/公斤体重）明显低于开放组（4.85、8.59、14.63 MME/kg bw/天，p<0.0001）和杂交组（4.13、6.84、11.36 MME/kg bw/天，p=0.008）。与开放组相比，RAMIE 组患者在术后第 5 天的静息（p=0.004）和活动（p<0.001）时疼痛评分较低。
本研究表明，与接受开放和杂交手术的患者相比，接受 RAMIE 治疗的患者在术后经历了相似的疼痛，但需要的阿片类药物明显减少。需要进一步的研究来验证结果。
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