Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Hospital and Institute, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China.
Ann Surg Oncol. 2023 Jul;30(7):3991-4000. doi: 10.1245/s10434-023-13430-6. Epub 2023 Apr 7.
Left recurrent laryngeal nerve (no.106recL) lymph node dissection is a challenging procedure, and robotic-assisted minimally invasive esophagectomy (RAMIE) may have some advantages. This study aimed to determine the learning curve of no.106recL lymph node dissection.
The data of 417 patients who underwent McKeown RAMIE between June 2017 and June 2022 were retrospectively analyzed. The lymph node harvest of no.106recL was used to determine the learning curve, and the cumulative sum (CUSUM) method was employed to obtain the inflection point.
A total of 404 patients (404/417, 96.9%) underwent robotic surgery. Based on the number of no.106recL lymph nodes harvested, the CUSUM learning curve was mapped and divided into three phases: phase I (1‒75 cases), phase II (76‒240 cases), and phase III (241‒404 cases). The median (IQR) number of no.106recL lymph node harvests were 1 (4), 3 (6,) and 4 (4) in each phase (p < 0.001). The lymph node dissection rate gradually increased from 62.7% in phase I to 82.9% in phase III (p = 0.001). The total and thoracic lymph node harvest gradually increased (p < 0.001), whereas operation time (p = 0.001) and blood loss gradually decreased (p < 0.001). Moreover, the incidence of total complication (p = 0.020) and recurrent laryngeal nerve injury (p = 0.001) significantly decreased, and the postoperative hospital stay gradually shortened (p < 0.001).
Robotic no.106recL lymph node dissection has some advantages for patients with esophageal cancer. In this study, perioperative and clinical outcomes were significantly improved over the learning curve. However, further prospective studies are required to confirm our results.
左侧喉返神经（no.106recL）淋巴结清扫是一项具有挑战性的操作，而机器人辅助微创食管切除术（RAMIE）可能具有一些优势。本研究旨在确定 no.106recL 淋巴结清扫的学习曲线。
回顾性分析 2017 年 6 月至 2022 年 6 月期间接受 McKeown RAMIE 的 417 例患者的数据。使用 no.106recL 淋巴结采集来确定学习曲线，并采用累积和（CUSUM）方法获得拐点。
共有 404 例患者（404/417，96.9%）接受了机器人手术。根据 no.106recL 淋巴结采集的数量，绘制了 CUSUM 学习曲线，并分为三个阶段：第 I 阶段（1-75 例）、第 II 阶段（76-240 例）和第 III 阶段（241-404 例）。每个阶段的 no.106recL 淋巴结采集的中位数（IQR）分别为 1（4）、3（6）和 4（4）（p<0.001）。淋巴结清扫率从第 I 阶段的 62.7%逐渐增加到第 III 阶段的 82.9%（p=0.001）。总淋巴结和胸内淋巴结采集逐渐增加（p<0.001），而手术时间（p=0.001）和出血量逐渐减少（p<0.001）。此外，总并发症发生率（p=0.020）和喉返神经损伤发生率（p=0.001）显著降低，术后住院时间逐渐缩短（p<0.001）。
机器人辅助 no.106recL 淋巴结清扫术对食管癌患者具有一定优势。在本研究中，学习曲线内围手术期和临床结果得到显著改善。然而，还需要进一步的前瞻性研究来证实我们的结果。
