机器人辅助与微创食管切除术治疗胸段食管癌患者的长期疗效：倾向评分匹配研究。
Long-term outcomes of robot-assisted versus minimally invasive esophagectomy in patients with thoracic esophageal cancer: a propensity score-matched study.
机构信息
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-1-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Department of Digestive Surgery, Kohsei Chuo General Hospital, 1-11-7 Mita, Meguro-ku, Tokyo, 153-8581, Japan.
出版信息
World J Surg Oncol. 2024 Mar 20;22(1):80. doi: 10.1186/s12957-024-03358-w.
BACKGROUND
Recently, robot-assisted minimally invasive esophagectomy (RAMIE) has gained popularity worldwide. Some studies have compared the long-term results of RAMIE and minimally invasive esophagectomy (MIE). However, there are no reports on the long-term outcomes of RAMIE in Japan. This study compared the long-term outcomes of RAMIE and MIE.
METHODS
This retrospective study included 86 patients with thoracic esophageal cancer who underwent RAMIE or MIE at our hospital from June 2010 to December 2016. Propensity score matching (PSM) was employed, incorporating co-variables such as confounders or risk factors derived from the literature and clinical practice. These variables included age, sex, body mass index, alcohol consumption, smoking history, American Society of Anesthesiologists stage, comorbidities, tumor location, histology, clinical TNM stage, and preoperative therapy. The primary endpoint was 5-year overall survival (OS), and the secondary endpoints were 5-year disease-free survival (DFS) and recurrence rates.
RESULTS
Before PSM, the RAMIE group had a longer operation time (min) than the MIE group (P = 0.019). RAMIE also exhibited significantly lower blood loss volume (mL) (P < 0.001) and fewer three-field lymph node dissections (P = 0.028). Postoperative complications (Clavien-Dindo: CD ≥ 2) were significantly lower in the RAMIE group (P = 0.04), and postoperative hospital stay was significantly shorter than the MIE group (P < 0.001). After PSM, the RAMIE and MIE groups consisted of 26 patients each. Blood loss volume was significantly smaller (P = 0.012), postoperative complications (Clavien-Dindo ≥ 2) were significantly lower (P = 0.021), and postoperative hospital stay was significantly shorter (P < 0.001) in the RAMIE group than those in the MIE group. The median observation period was 63 months. The 5-year OS rates were 73.1% and 80.8% in the RAMIE and MIE groups, respectively (P = 0.360); the 5-year DFS rates were 76.9% and 76.9% in the RAMIE and MIE groups, respectively (P = 0.749). Six of 26 patients (23.1%) in each group experienced recurrence, with a median recurrence period of 41.5 months in the RAMIE group and 22.5 months in the MIE group.
CONCLUSIONS
Compared with MIE, RAMIE led to no differences in long-term results, suggesting that RAMIE is a comparable technique.
背景
最近，机器人辅助微创食管切除术（RAMIE）在全球范围内得到了普及。一些研究比较了 RAMIE 和微创食管切除术（MIE）的长期结果。然而，目前尚无关于日本 RAMIE 长期结果的报道。本研究比较了 RAMIE 和 MIE 的长期结果。
方法
本回顾性研究纳入了 2010 年 6 月至 2016 年 12 月在我院接受 RAMIE 或 MIE 治疗的 86 例胸段食管癌患者。采用倾向评分匹配（PSM），纳入了来自文献和临床实践的混杂因素或危险因素等协变量。这些变量包括年龄、性别、体重指数、饮酒史、吸烟史、美国麻醉师协会（ASA）分级、合并症、肿瘤位置、组织学、临床 TNM 分期和术前治疗。主要终点为 5 年总生存率（OS），次要终点为 5 年无病生存率（DFS）和复发率。
结果
在 PSM 之前，RAMIE 组的手术时间（min）长于 MIE 组（P=0.019）。RAMIE 组的术中出血量（mL）显著减少（P<0.001），三野淋巴结清扫术的数量也较少（P=0.028）。RAMIE 组术后并发症（Clavien-Dindo 分级≥2）发生率显著低于 MIE 组（P=0.04），术后住院时间显著短于 MIE 组（P<0.001）。PSM 后，RAMIE 组和 MIE 组各纳入 26 例患者。RAMIE 组的术中出血量显著减少（P=0.012），术后并发症（Clavien-Dindo 分级≥2）发生率显著降低（P=0.021），术后住院时间显著缩短（P<0.001）。中位观察期为 63 个月。RAMIE 组和 MIE 组的 5 年 OS 率分别为 73.1%和 80.8%（P=0.360）；DFS 率分别为 76.9%和 76.9%（P=0.749）。两组各有 6 例（23.1%）患者复发，RAMIE 组和 MIE 组的中位复发时间分别为 41.5 个月和 22.5 个月。
结论
与 MIE 相比，RAMIE 并未导致长期结果的差异，提示 RAMIE 是一种可比较的技术。
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