食管癌切除术后胃上提重建后再次行机器人辅助挽救性肺叶切除术：一例报告

Re-do robot-assisted salvage lobectomy after esophagectomy with gastric pull-up reconstruction: a case report.

作者信息

Shahin Ghada, Kharbanda Rohit, Tummers Quirijn, Braun Jerry

机构信息

Department of Cardiothoracic Surgery, Leiden University Medical Center, Subspecialty Thoracic Surgery, Albinusdreef 2, Leiden, ZA, 2333, the Netherlands.

Department of Surgery, Antoni Van Leeuwenhoek Hospital, Subspecialty Thoracic Surgery, Amsterdam, the Netherlands.

出版信息

World J Surg Oncol. 2025 Apr 8;23(1):128. doi: 10.1186/s12957-025-03661-0.

DOI:10.1186/s12957-025-03661-0

PMID:40200362

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11980297/

Abstract

BACKGROUND

Robot-assisted Thoracic Surgery (RATS) is well-established for complex minimally invasive thoracic surgery. Despite the available literature, robotics for complex advanced NSCLC for re-do surgery remains underexplored.

CASE PRESENTATION

We present a 55-year-old female who underwent esophagectomy with gastric pull-up reconstruction for squamous cell carcinoma (SCC) of the esophagus (cT3N2M0, stage IIIB) after neo-adjuvant concurrent chemoradiation therapy (ypT2N1 stage IIB disease). Six years later, computed tomography (CT) scan showed stage IA Thyroid Transcription Factor-1 (TTF-1) positive adenocarcinoma in the left upper lobe treated by stereotactic radiotherapy. Two years later, a SCC of the right upper lobe (RUL) was found (Fig. 1). Although locoregional therapy was preferred Pembrolizumab® was initiated with curative intent as the tumor demonstrated a high Programmed Death-Ligand 1 (PD-L1) expression. Follow-up CT-scan showed no biological response. Salvage lobectomy was proposed, and patient consent obtained. As demonstrated in the video, RATS provided great exposure to the adhesions, vascularization of the neo-oesophagus and maximal dexterity in difficult spaces.

CONCLUSIONS

This case demonstrates the value of RATS in complex re-do thoracic surgery after immunotherapy and previous thoracotomy.

摘要

背景

机器人辅助胸外科手术（RATS）在复杂的微创胸外科手术中已得到广泛应用。尽管已有相关文献报道，但机器人技术在复杂晚期非小细胞肺癌再次手术中的应用仍未得到充分探索。

病例介绍

我们报告一名55岁女性，在新辅助同步放化疗后（ypT2N1，IIB期疾病），因食管鳞状细胞癌（SCC）接受了食管切除术并胃上提重建术（cT3N2M0，IIIB期）。六年后，计算机断层扫描（CT）显示左上叶出现IA期甲状腺转录因子-1（TTF-1）阳性腺癌，接受了立体定向放射治疗。两年后，发现右上叶（RUL）出现SCC（图1）。尽管首选局部区域治疗，但由于肿瘤显示出高程序性死亡配体1（PD-L1）表达，因此开始使用帕博利珠单抗®进行治疗，以期治愈。随访CT扫描显示无生物学反应。建议进行挽救性肺叶切除术，并获得了患者同意。如视频所示，RATS在暴露粘连、新食管血管化以及在困难空间中提供最大灵活性方面表现出色。