机器人辅助微创食管切除术与胸腔镜手术的比较：短期结果的多机构研究。

Robot-assisted minimally invasive oesophagectomy versus thoracoscopic approach: multi-institutional study on short-term outcomes.

机构信息

Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Tao-Yuan, Taiwan.

Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

出版信息

BJS Open. 2024 Jul 2;8(4). doi: 10.1093/bjsopen/zrae063.

DOI:10.1093/bjsopen/zrae063

PMID:39041732

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11264138/

Abstract

BACKGROUND

Robot-assisted minimally invasive oesophagectomy and conventional minimally invasive oesophagectomy are superior to open techniques. However, few studies have directly compared the outcomes of the two minimally invasive approaches.

METHODS

A retrospective study of patients from six medical centres with oesophageal squamous cell carcinoma who underwent minimally invasive oesophagectomy between 2015 and 2022. Perioperative outcomes were compared after applying inverse probability of treatment weighting.

RESULTS

The study included 577 patients (robot-assisted minimally invasive oesophagectomy: 206; conventional minimally invasive oesophagectomy: 371). After applying inverse probability of treatment weighting, robot-assisted minimally invasive oesophagectomy was found to yield a higher number of mediastinal nodes compared with conventional minimally invasive oesophagectomy (14.86 versus 12.66, P = 0.017). Robot-assisted minimally invasive oesophagectomy was notably effective in retrieving upper mediastinal left recurrent laryngeal nerve nodes, averaging 1.97 nodes versus 1.14 nodes harvested by conventional minimally invasive oesophagectomy (P < 0.001). This was coupled by a significant decrease in nerve palsy rates (13.9% versus 22.8%, P = 0.020). A significantly larger percentage of patients in the robot-assisted minimally invasive oesophagectomy group had an uncomplicated postoperative course (51.8% versus 34%, P < 0.001). Robot-assisted minimally invasive oesophagectomy also led to a reduction in pneumonia rates (8.6% versus 15.2%, P = 0.041) and was linked to a shorter length of stay (length of stay; 16.64 versus 21.14 days, P = 0.007). The advantage of robot-assisted minimally invasive oesophagectomy in reducing the length of stay was especially pronounced in patients with a high Charlson co-morbidity index (≥2, mean difference 8.46 days; P = 0.0069) and those who underwent neoadjuvant therapy (mean difference 5.63 days; P < 0.001).

CONCLUSION

In oesophageal squamous cell carcinoma, the use of robot-assisted minimally invasive oesophagectomy led to fewer cases of pneumonia and faster recovery compared with conventional minimally invasive oesophagectomy. Additionally, robot-assisted minimally invasive oesophagectomy significantly improved the feasibility and safety of performing lymph node dissection along the recurrent laryngeal nerve.

摘要

背景

机器人辅助微创食管切除术和传统微创食管切除术优于开放技术。然而，很少有研究直接比较这两种微创方法的结果。

方法

对 2015 年至 2022 年间在 6 家医疗中心接受微创食管切除术的食管鳞状细胞癌患者进行回顾性研究。应用逆概率治疗加权后比较围手术期结果。

结果

该研究纳入了 577 例患者（机器人辅助微创食管切除术 206 例，传统微创食管切除术 371 例）。应用逆概率治疗加权后，机器人辅助微创食管切除术比传统微创食管切除术获得更多的纵隔淋巴结（14.86 对 12.66，P=0.017）。机器人辅助微创食管切除术在获取上纵隔左侧喉返神经淋巴结方面具有显著优势，平均为 1.97 个淋巴结，而传统微创食管切除术为 1.14 个淋巴结（P<0.001）。由此导致的神经麻痹发生率显著降低（13.9%对 22.8%，P=0.020）。机器人辅助微创食管切除术组中术后无并发症的患者比例显著更高（51.8%对 34%，P<0.001）。机器人辅助微创食管切除术还降低了肺炎发生率（8.6%对 15.2%，P=0.041），并与较短的住院时间相关（住院时间；16.64 对 21.14 天，P=0.007）。在 Charlson 合并症指数较高（≥2，平均差异 8.46 天；P=0.0069）和接受新辅助治疗的患者中（平均差异 5.63 天；P<0.001），机器人辅助微创食管切除术在缩短住院时间方面的优势更为明显。