Departments of Endoscopy Diagnosis and Therapy, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
Department of Rehabilitation Therapy, Langfang Health Vocational College, Langfang, China.
Thorac Cancer. 2024 Jun;15(18):1446-1453. doi: 10.1111/1759-7714.15334. Epub 2024 May 21.
To determine the safety and efficacy of robot-assisted minimally invasive esophagectomy (RAMIE) for locally advanced esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemoimmunotherapy (NCI).
Data from patients who underwent RAMIE between January 2020 and June 2022 were retrospectively analyzed. The oncological and operative outcomes of the NCI and surgery-only (S) groups were compared by both unmatched and 1:1 propensity score-matched (PSM) analysis.
A total of 201 patients with ESCC who underwent three-incision RAMIE were included in this study (143 patients in the S group and 58 patients in the NCI group). Of the 58 patients who underwent NCI, a pathologically complete response (pCR) (ypT0N0) was identified in 14 (24.1%) patients. The patients in the NCI group were younger than those in the S group (p = 0.017), and had more advanced cT (p < 0.001) and cN stage diseases (p = 0.002). After 1:1 PSM of the confounders, 55 patients were allocated to each of the NCI and S groups. No significant differences were found in oncological and operative results, including surgical blood loss, operative time, and lymph node harvest (all p > 0.05). However, the NCI group exhibited a lower rate of pulmonary complications than the S group (3.6% vs. 14.5%, p = 0.047). No significant difference between the groups was found for other complications (all p > 0.05).
These findings indicate that NCI could result in a high pCR rate without increased complications in locally advanced ESCC. RAMIE is safe and feasible in patients with ESCC after NCI.
评估新辅助化疗免疫治疗（NCI）后机器人辅助微创食管切除术（RAMIE）治疗局部晚期食管鳞状细胞癌（ESCC）的安全性和有效性。
回顾性分析 2020 年 1 月至 2022 年 6 月期间接受 RAMIE 治疗的患者数据。通过非匹配和 1:1 倾向评分匹配（PSM）分析比较 NCI 组和手术组（S 组）的肿瘤学和手术结果。
本研究共纳入 201 例接受三切口 RAMIE 的 ESCC 患者（S 组 143 例，NCI 组 58 例）。在接受 NCI 的 58 例患者中，14 例（24.1%）患者病理完全缓解（ypT0N0）。NCI 组患者年龄小于 S 组（p=0.017），且 cT（p<0.001）和 cN 期疾病更晚期（p=0.002）。在对混杂因素进行 1:1 PSM 后，每组分配 55 例患者。在肿瘤学和手术结果方面，包括手术失血量、手术时间和淋巴结清扫（均 p>0.05），两组间无显著差异。然而，NCI 组的肺部并发症发生率低于 S 组（3.6% vs. 14.5%，p=0.047）。两组间其他并发症发生率无显著差异（均 p>0.05）。
这些发现表明，NCI 可在不增加局部晚期 ESCC 并发症的情况下获得高病理完全缓解率。NCI 后 RAMIE 治疗 ESCC 安全可行。
