Koterazawa Yasufumi, Goto Hironobu, Aoki Tomoaki, Sawada Ryuichiro, Ikeda Taro, Harada Hitoshi, Otowa Yasunori, Urakawa Naoki, Hasegawa Hiroshi, Kanaji Shingo, Yamashita Kimihiro, Matsuda Takeru, Oshikiri Taro, Kakeji Yoshihiro
Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe City, 650-0017, Japan.
Division of Analytical Biomedical Sciences, Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe City, Hyogo, Japan.
Surg Endosc. 2025 May 14. doi: 10.1007/s00464-025-11713-5.
Several studies have compared robot-assisted minimally invasive esophagectomy (RAMIE) with conventional minimally invasive surgery (C-MIE). However, the anatomical factors that may make certain patients more suitable for RAMIE remains unclear. This study compared the surgical outcomes of RAMIE with those of C-MIE in patients with narrow mediastinum and left-shifted esophagus.
Between January 2017 and December 2023, 260 patients with esophageal squamous cell carcinoma (ESCC) who underwent MIE (C-MIE or RAMIE) at Kobe University Hospital were included in the study. We developed a new index to assess the narrow mediastinum and left-shifted esophagus at the tracheal bifurcation level using computed tomography imaging. Cox proportional hazards regression analyses were performed to identify the prognostic factors.
Patients with a narrow mediastinum and left-shifted esophagus had a higher incidence of recurrent laryngeal nerve (RLN) palsy and fewer lymph nodes dissections than other patients (p = 0.026 and p = 0.051, respectively). In the entire cohort, the operative time in the RAMIE group was longer than that in the C-MIE group (< 0.0001). No significant differences in other variables, including RLN palsy, were observed between the two groups. Among patients with narrow mediastinum and left-shifted esophagus, RAMIE was associated with longer operative time and fewer lymph nodes dissected from the left and right sides of the upper mediastinum compared to C-MIE (p < 0.0001, 0.0001, and 0.0001, respectively). Regarding the RLN palsy, there was no significant difference (p = 0.79).
There are challenges in performing RAMIE in patients with a narrow mediastinal and left-shifted esophagus. Therefore, establishing an effective procedure for these patients is important.
多项研究已将机器人辅助微创食管切除术（RAMIE）与传统微创手术（C-MIE）进行了比较。然而，可能使某些患者更适合RAMIE的解剖学因素仍不清楚。本研究比较了RAMIE与C-MIE在纵隔狭窄和食管左移患者中的手术结果。
2017年1月至2023年12月期间，在神户大学医院接受MIE（C-MIE或RAMIE）的260例食管鳞状细胞癌（ESCC）患者纳入本研究。我们开发了一种新的指标，使用计算机断层扫描成像在气管分叉水平评估纵隔狭窄和食管左移情况。进行Cox比例风险回归分析以确定预后因素。
纵隔狭窄和食管左移患者的喉返神经（RLN）麻痹发生率高于其他患者，且淋巴结清扫数量少于其他患者（分别为p = 0.026和p = 0.051）。在整个队列中，RAMIE组的手术时间比C-MIE组长（<0.0001）。两组在包括RLN麻痹在内的其他变量方面未观察到显著差异。在纵隔狭窄和食管左移患者中，与C-MIE相比，RAMIE的手术时间更长，上纵隔左右两侧清扫的淋巴结数量更少（分别为p < 0.0001、0.0001和0.0001）。关于RLN麻痹，差异无统计学意义（p = 0.79）。
对纵隔狭窄和食管左移的患者进行RAMIE存在挑战。因此，为这些患者建立有效的手术方法很重要。
