Weindelmayer Jacopo, De Pasqual Carlo Alberto, Turolo Cecilia, Gervasi Maria Clelia, Sacco Michele, Bencivenga Maria, Giacopuzzi Simone
Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy.
J Surg Oncol. 2023 Jun;127(7):1109-1115. doi: 10.1002/jso.27246. Epub 2023 Mar 27.
Robotic-assisted minimally invasive esophagectomy (RAMIE) combines the beneficial effects of minimally invasive surgery on postoperative complications, especially on pulmonary ones, with the safety of the anastomosis performed in open surgery. Moreover, RAMIE could allow a more accurate lymphadenectomy.
We reviewed our database to identify all patients with adenocarcinoma of the esophagus treated by Ivor-Lewis esophagectomy in the period January 2014 to June 2022. Patients were divided according to the thoracic approach into RAMIE and open esophagectomy (OE) groups. We compared the groups for early surgical outcomes, 90-day mortality as well as R0 rate, and the number of lymph nodes harvested.
We identified 47 patients in RAMIE and 159 patients in the OE group. Baseline characteristics were comparable. Operative time was significantly longer for RAMIE procedures (p < 0.01); however, we did not observe the difference in overall (RAMIE 55.5% vs. OE 61%, p = 0.76) and severe complications rate (RAMIE 17% vs. OE 22.6%, p = 0.4). The anastomotic leak rate was 2.1% after RAMIE and 6.9% after OE (p = 0.56). We did not report the difference in 90-day mortality (RAMIE 2.1% vs. OE 1.9%, p = 0.65). In the RAMIE group, we observed a significantly higher number of thoracic lymph nodes harvested, with a median of 10 lymph nodes in the RAMIE group versus 8 in the OE group (p < 0.01).
In our experience, RAMIE has morbimortality rates comparable to OE. Moreover, it allows a more accurate thoracic lymphadenectomy which results in a higher thoracic lymph nodes retrieval rate.
机器人辅助微创食管切除术（RAMIE）将微创手术对术后并发症（尤其是肺部并发症）的有益影响与开放手术中吻合术的安全性相结合。此外，RAMIE可以实现更精确的淋巴结清扫。
我们回顾了数据库，以确定2014年1月至2022年6月期间接受艾弗·刘易斯食管切除术治疗的所有食管腺癌患者。根据胸段手术方式将患者分为RAMIE组和开放食管切除术（OE）组。我们比较了两组的早期手术结果、90天死亡率、R0切除率以及清扫的淋巴结数量。
我们在RAMIE组中确定了47例患者，在OE组中确定了159例患者。基线特征具有可比性。RAMIE手术的手术时间明显更长（p < 0.01）；然而，我们未观察到总体并发症发生率（RAMIE为55.5% vs. OE为61%，p = 0.76）和严重并发症发生率（RAMIE为17% vs. OE为22.6%，p = 0.4）存在差异。RAMIE术后吻合口漏发生率为2.1%，OE术后为6.9%（p = 0.56）。我们未报告90天死亡率存在差异（RAMIE为2.1% vs. OE为1.9%，p = 0.65）。在RAMIE组中，我们观察到清扫的胸段淋巴结数量明显更多，RAMIE组的中位数为10个淋巴结，而OE组为8个（p < 0.01）。
根据我们的经验，RAMIE的发病率和死亡率与OE相当。此外，它可以实现更精确的胸段淋巴结清扫，从而提高胸段淋巴结的获取率。
