Kwon Yelee, Yun Jae Kwang, Jeon Yun-Ho, Kim Yong-Hee
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine, Daegu, Republic of Korea.
Eur J Surg Oncol. 2025 May;51(5):109591. doi: 10.1016/j.ejso.2025.109591. Epub 2025 Jan 9.
This study aimed to compare the long-term oncologic outcomes of robot-assisted minimally invasive esophagectomy (RAMIE) with those of conventional open esophagectomy (OE) for esophageal cancer.
Between January 2006 and December 2021, 1745 consecutive patients underwent esophagectomy for esophageal cancer at Asan Medical Center, Korea. Among them, we retrieved 1133 patients (mean age 63.1 ± 7.8 years, 86 [7.6 %] women, 1100 [97.1 %] squamous cell carcinomas), who were operated by a single surgeon. These patients were categorized into following two groups based on their surgical approaches: RAMIE (n = 497) and OE (n = 636). The RAMIE and OE groups were matched in a 1:1 ratio using propensity scores. Overall survival (OS) and recurrence-free survival (RFS) were compared between the groups.
The median follow-up was 51.8 (24.6-90.2, interquartile) months. Five-year OS (70.7 % vs. 55.0 %, P < 0.01) and RFS (63.3 % vs. 50.1 %, P < 0.01) rates were significantly higher in RAMIE than in OE group. Following propensity-score matching, 886 patients (443 pairs) were successfully matched, demonstrating no significant intergroup differences, including the pathologic stage. The RAMIE group consistently demonstrated enhanced OS (70.4 % vs. 61.8 %, P < 0.01) and RFS (62.8 % vs. 55.8 %, P = 0.04) after five years, even after adjustment. The rate of noncancer mortality was significantly higher in the OE group (P < 0.01), whereas the rate of esophageal cancer-related mortality showed no significant differences between the groups (P = 0.25).
RAMIE could be a safer option for patients compared with conventional open esophagectomy with favorable long-term outcomes related to noncancer mortality.
本研究旨在比较机器人辅助微创食管切除术（RAMIE）与传统开放性食管切除术（OE）治疗食管癌的长期肿瘤学结局。
2006年1月至2021年12月期间，韩国峨山医学中心1745例连续患者接受了食管癌食管切除术。其中，我们纳入了1133例患者（平均年龄63.1±7.8岁，女性86例[7.6%]，鳞状细胞癌1100例[97.1%]），均由同一外科医生手术。根据手术方式，将这些患者分为以下两组：RAMIE组（n = 497）和OE组（n = 636）。使用倾向评分以1:1的比例对RAMIE组和OE组进行匹配。比较两组的总生存期（OS）和无复发生存期（RFS）。
中位随访时间为51.8（24.6 - 90.2，四分位间距）个月。RAMIE组的5年OS率（70.7%对55.0%，P < 0.01）和RFS率（63.3%对50.1%，P < 0.01）显著高于OE组。倾向评分匹配后，886例患者（443对）成功匹配，组间无显著差异，包括病理分期。即使在调整后，RAMIE组5年后的OS（70.4%对61.8%，P < 0.01）和RFS（62.8%对55.8%，P = 0.04）仍持续改善。OE组的非癌症死亡率显著更高（P < 0.01），而两组之间的食管癌相关死亡率无显著差异（P = 0.25）。
与传统开放性食管切除术相比，RAMIE对患者可能是一种更安全的选择，在非癌症死亡率方面具有良好的长期结局。
