机器人辅助和腹腔镜下Ivor Lewis食管癌切除术后的教科书式结局与生存率提高相关：一项倾向评分匹配分析。
Textbook outcome after robotic and laparoscopic Ivor Lewis esophagectomy is associated with improved survival: A propensity score-matched analysis.
作者信息
Seika Philippa, Maurer Max M, Winter Axel, Ossami-Saidy Ramin Raul, Serwah Armanda, Ritschl Paul V, Raakow Jonas, Dobrindt Eva, Kurreck Annika, Pratschke Johann, Biebl Matthias, Denecke Christian
机构信息
Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Charité Universitätsmedizin Berlin, Berlin, Germany.
出版信息
J Thorac Cardiovasc Surg. 2025 Jun;169(6):1604-1615. doi: 10.1016/j.jtcvs.2024.11.008. Epub 2024 Nov 16.
BACKGROUND
Esophagectomy is central to curative therapy for esophageal cancer (EC). Perioperative outcomes affect both disease-free survival (DFS) and overall survival (OS) in patients undergoing oncologic esophageal surgery. The adoption of robotic techniques may improve surgical outcomes; however, the complex nature of perioperative outcomes is not adequately captured by individual quality measures.
METHODS
All EC patients after minimally invasive esophagectomy (MIE) or robotic-assisted MIE (RAMIE) junction between 2015 and 2022 were included. Textbook outcome (TO) was defined as negative resection margin (R0), retrieval of >20 lymph nodes, no major complications, no reinterventions, no intensive care unit readmission, no 30-day readmission or mortality, and hospital stay <21 days. Individual propensity scores were calculated using a logistic regression model. Factors affecting TO were evaluated using a logistic regression model, and a multivariate Cox proportional hazards model was used to evaluate TO and survival.
RESULTS
Of 236 patients included in this study, 106 (44.91%) achieved TO. TO was achieved in 71 patients after MIE (41.21%) and in 31 patients after RAMIE (57.41%; P = .036). RAMIE was associated with achievement of TO (odds ratio, 2.01; 95% confidence interval [CI], 1.07-3.80; P = .031) in the overall cohort. Achievement of TO was due to a reduction in major complications in the RAMIE group. Patients with perioperative TO had higher 3-year DFS and OS rates (univariate analysis [UV]: hazard ratio [HR], 2.49; 95% CI, 1.18-5.26; P = .016; multivariate analysis [MV]: HR, 4.30; 95% CI, 1.60-11.55; P = .004) compared to those without perioperative TO and disease-free survival (UV: HR, 2.28; 95% CI, 1.24-4.19; P = .008; MV: HR, 2.82; 95% CI, 1.26-6.32; P = .011) at the 2-year follow-up.
CONCLUSIONS
RAMIE is associated with increased TO achievement. Achieving TO is associated with enhanced long-term survival in EC patients and warrants continued emphasis on surgical quality improvement.
背景
食管切除术是食管癌（EC）根治性治疗的核心。围手术期结果影响接受肿瘤性食管手术患者的无病生存期（DFS）和总生存期（OS）。采用机器人技术可能会改善手术结果；然而，个体质量指标并未充分体现围手术期结果的复杂性。
方法
纳入2015年至2022年间接受微创食管切除术（MIE）或机器人辅助MIE（RAMIE）的所有EC患者。教科书式结局（TO）定义为切缘阴性（R0）、切除淋巴结>20枚、无重大并发症、无需再次干预、无重症监护病房再入院、无30天再入院或死亡以及住院时间<21天。使用逻辑回归模型计算个体倾向评分。使用逻辑回归模型评估影响TO的因素，并使用多变量Cox比例风险模型评估TO与生存率。
结果
本研究纳入的236例患者中，106例（44.91%）达到TO。MIE术后71例（41.21%）达到TO，RAMIE术后31例（57.41%）达到TO（P = 0.036）。在整个队列中，RAMIE与TO的实现相关（优势比，2.01；95%置信区间[CI]，1.07 - 3.80；P = 0.031）。TO的实现归因于RAMIE组重大并发症的减少。围手术期达到TO的患者在3年DFS和OS率方面更高（单变量分析[UV]：风险比[HR]，2.49；95% CI，1.18 - 5.26；P = 0.016；多变量分析[MV]：HR，4.30；95% CI，1.60 - 11.55；P = 0.004），与未达到围手术期TO的患者相比，在2年随访时无病生存期也更高（UV：HR，2.28；95% CI，1.24 - 4.19；P = 0.008；MV：HR，2.82；95% CI，1.26 - 6.32；P = 0.011）。
结论
RAMIE与TO实现率的提高相关。实现TO与EC患者长期生存率的提高相关，值得继续强调手术质量的改善。
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