机器人辅助微创食管切除术与胸腔镜方法:多机构短期疗效研究。

IF 3.5 3区 医学 Q1 SURGERY BJS Open Pub Date : 2024-07-02 DOI:10.1093/bjsopen/zrae063
Yin-Kai Chao, Jui-Ying Lee, Wen-Chien Huang, Jang-Ming Lee, Yau-Lin Tseng, Hung-I Lu
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引用次数: 0

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均优于开放式技术。然而,很少有研究直接比较两种微创方法的疗效:对2015年至2022年期间在六个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。采用逆治疗概率加权法对围手术期结果进行了比较:研究共纳入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)。在应用逆治疗概率加权法后发现,与传统微创食管切除术相比,机器人辅助微创食管切除术产生的纵隔结节数量更高(14.86 对 12.66,P = 0.017)。机器人辅助微创食管切除术在取回上纵隔左喉返神经结节方面效果显著,平均取回1.97个结节,而传统微创食管切除术取回1.14个结节(P < 0.001)。同时,神经麻痹率也显著下降(13.9% 对 22.8%,P = 0.020)。机器人辅助微创食管切除术组患者术后无并发症的比例明显更高(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),并缩短了住院时间(住院时间:16.64天对21.14天,P = 0.007)。机器人辅助微创食管切除术在缩短住院时间方面的优势在夏尔森共病指数较高的患者(≥2,平均相差8.46天;P = 0.0069)和接受新辅助治疗的患者(平均相差5.63天;P < 0.001)中尤为明显:在食管鳞状细胞癌中,与传统的微创食管切除术相比,使用机器人辅助微创食管切除术可减少肺炎病例的发生,并加快康复速度。此外,机器人辅助微创食管切除术大大提高了沿喉返神经进行淋巴结清扫的可行性和安全性。
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Robot-assisted minimally invasive oesophagectomy versus thoracoscopic approach: multi-institutional study on short-term outcomes.

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.

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BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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