Betzler Johanna, Elfinger Lea, Büttner Sylvia, Weiß Christel, Rahbari Nuh, Betzler Alexander, Reißfelder Christoph, Otto Mirko, Blank Susanne, Schölch Sebastian
Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Junior Clinical Cooperation Unit Translational Surgical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Front Oncol. 2022 Aug 17;12:966321. doi: 10.3389/fonc.2022.966321. eCollection 2022.
Although the introduction of minimally invasive surgical techniques has improved surgical outcomes in recent decades, esophagectomy for esophageal cancer is still associated with severe complications and a high mortality rate. Robot-assisted surgery is already established in certain fields and robot-assisted esophagectomy may be a possible alternative to the standard minimally invasive esophagectomy. The goal of this study was to investigate whether robot assistance in esophagectomy can improve patient outcome while maintaining good oncological control.
Data of all patients who underwent minimally invasive esophagectomy between January 2018 and November 2021 at University Hospital Mannheim was collected retrospectively. Patients were divided into two cohorts according to operative technique (standard minimally invasive (MIE) vs. robot-assisted esophagectomy (RAMIE), and their outcomes compared. In a separate analysis, patients were propensity score matched according to age, gender and histological diagnosis, leading to 20 matching pairs.
95 patients were included in this study. Of those, 71 patients underwent robot-assisted esophagectomy and 24 patients underwent standard minimally invasive esophagectomy. Robot-assisted esophagectomy showed a lower incidence of general postoperative complications (52.1% vs. 79.2%, p=0.0198), surgical complications (42.3% vs. 75.0%, p=0.0055), a lower rate of anastomotic leakage (21.1% vs. 50.0%, p=0.0067), a lower Comprehensive Complication Index (median of 20.9 vs. 38.6, p=0.0065) as well as a shorter duration of hospital stay (median of 15 vs. 26 days, p=0.0012) and stay in the intensive care unit (median of 4 vs. 7 days, p=0.028) than standard minimally invasive surgery. After additionally matching RAMIE and MIE patients according to age, gender and diagnosis, we found significant improvement in the RAMIE group compared to the MIE group regarding the Comprehensive Complication Index (median of 20.9 vs. 38.6, p=0.0276), anastomotic leakage (20% vs. 55%, p=0.0484) and severe toxicity during neoadjuvant treatment (0 patients vs. 9 patients, p=0.005).
Robot-assisted surgery can significantly improve outcomes for patients with esophageal cancer. It may lead to a shorter hospital stay as well as lower rates of complications, including anastomotic leakage.
尽管近几十年来微创外科技术的引入改善了手术效果，但食管癌的食管切除术仍与严重并发症和高死亡率相关。机器人辅助手术已在某些领域得到应用，机器人辅助食管切除术可能是标准微创食管切除术的一种替代方案。本研究的目的是调查机器人辅助食管切除术在保持良好肿瘤学控制的同时能否改善患者预后。
回顾性收集2018年1月至2021年11月在曼海姆大学医院接受微创食管切除术的所有患者的数据。根据手术技术将患者分为两组（标准微创食管切除术（MIE）与机器人辅助食管切除术（RAMIE）），并比较他们的预后。在一项单独分析中，根据年龄、性别和组织学诊断对患者进行倾向得分匹配，得到20对匹配组。
本研究纳入95例患者。其中，71例患者接受了机器人辅助食管切除术，24例患者接受了标准微创食管切除术。机器人辅助食管切除术显示出总体术后并发症发生率较低（52.1%对79.2%，p = 0.0198）、手术并发症发生率较低（42.3%对75.0%，p = 0.0055）、吻合口漏发生率较低（21.1%对50.0%，p = 0.0067）、综合并发症指数较低（中位数为20.9对38.6，p = 0.0065），以及住院时间较短（中位数为15天对26天，p = 0.0012）和重症监护病房住院时间较短（中位数为4天对7天，p = 0.028），均优于标准微创手术。在根据年龄、性别和诊断对RAMIE和MIE患者进行额外匹配后，我们发现RAMIE组在综合并发症指数（中位数为20.9对38.6，p = 0.0276）、吻合口漏（20%对55%，p = 0.0484）和新辅助治疗期间的严重毒性反应（0例对9例，p = 0.005）方面与MIE组相比有显著改善。
机器人辅助手术可显著改善食管癌患者的预后。它可能导致住院时间缩短以及并发症发生率降低，包括吻合口漏。
