Yang Yuxin, Li Bin, Xu Xinyi, Liu Zhichao, Jiang Chao, Wu Xiaolu, Yang Yang, Li Zhigang
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Eur J Surg Oncol. 2023 Oct;49(10):107009. doi: 10.1016/j.ejso.2023.107009. Epub 2023 Aug 5.
Robot-assisted minimally invasive esophagectomy (RAMIE) was reported to have superiority in upper mediastinal lymph nodes dissection than traditional approach, but related injuries to recurrent laryngeal nerve (RLNI) cannot be avoided. Considering that there is no study centering on RLNI during robotic manipulation, this study aimed to investigate the impact of RLNI on the short-term and long-term outcomes after RAMIE.
Patients with esophageal cancer (EC) who underwent RAMIE from June 2015 to July 2019 were collated from a prospectively maintained database. Short-term and long-term outcomes of RLNI were analyzed.
A total of 409 patients were included with the incidence of RLNI being 18.6% (76/409). A higher rate of postoperative pulmonary complications including pneumonia (P < 0.001) and acute respiratory distress syndrome (ARDS) (P = 0.041) was associated with RLNI, requiring more interventions for bronchoscopy airway suction (P < 0.001), tracheal reintubation (P = 0.013) and tracheostomy (P < 0.001). Patients with RLNI had a prolonged length of hospitalization and intensive care unit (ICU) stay (P < 0.001). With the median follow-up time of 48.7 (interquartile range [IQR]:27.6-60.9) months, recurrence in regional lymph nodes at mediastinum did not differ between groups (P = 0.351). Similarly, the Kaplan-Meier curves revealed no significant divergency for overall survival after RLNI (P = 0.452).
RLNI after robotic esophagectomy is a serious morbidity associated with an increased rate of pulmonary complications, prolonged length of hospitalization with limited influence on long-term prognosis.
据报道，机器人辅助微创食管切除术（RAMIE）在上纵隔淋巴结清扫方面比传统方法更具优势，但不可避免会出现与喉返神经（RLNI）相关的损伤。鉴于目前尚无关于机器人操作过程中喉返神经的研究，本研究旨在探讨喉返神经损伤对RAMIE术后短期和长期预后的影响。
从一个前瞻性维护的数据库中整理出2015年6月至2019年7月接受RAMIE的食管癌（EC）患者。分析喉返神经损伤的短期和长期预后。
共纳入409例患者，喉返神经损伤发生率为18.6%（76/409）。喉返神经损伤与术后肺部并发症发生率较高相关，包括肺炎（P<0.001）和急性呼吸窘迫综合征（ARDS）（P=0.041），需要更多的支气管镜气道吸引（P<0.001）、气管再插管（P=0.013）和气管切开术（P<0.001）干预。喉返神经损伤患者的住院时间和重症监护病房（ICU）停留时间延长（P<0.001）。中位随访时间为48.7（四分位间距[IQR]：27.6-60.9）个月，纵隔区域淋巴结复发在两组间无差异（P=0.351）。同样， Kaplan-Meier曲线显示喉返神经损伤后总生存率无显著差异（P=0.452）。
机器人食管切除术后喉返神经损伤是一种严重的并发症，与肺部并发症发生率增加、住院时间延长相关，对长期预后影响有限。
