Philippa Seika, Max M Maurer, Axel Winter, Ramin Raul Ossami-Saidy, Armanda Serwah, Paul V Ritschl, Jonas Raakow, Eva Dobrindt, Annika Kurreck, Johann Pratschke, Matthias Biebl, Christian Denecke
{"title":"机器人和腹腔镜 Ivor Lewis 食管切除术后的教科书结果与生存率的提高有关--倾向得分匹配分析。","authors":"Philippa Seika, Max M Maurer, Axel Winter, Ramin Raul Ossami-Saidy, Armanda Serwah, Paul V Ritschl, Jonas Raakow, Eva Dobrindt, Annika Kurreck, Johann Pratschke, Matthias Biebl, Christian Denecke","doi":"10.1016/j.jtcvs.2024.11.008","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Esophagectomy is central to curative therapy for esophageal cancer (EC). Perioperative outcomes affect both disease-free and overall survival in oncological esophageal surgery. The adoption of robotic techniques may improve surgical outcome. However, the complex nature of perioperative outcomes is not adequately captured by individual quality measures.</p><p><strong>Methods: </strong>All patients after minimally invasive esophagectomy (MIE) or robotic-assisted MIE (RAMIE) junction between 2015 and 2022 were included. Textbook outcome was defined as negative resection margins (R0), retrieval of >20 lymph nodes, no major complications, reinterventions, ICU readmission, 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 while multivariate Cox proportional-hazards model was used to evaluate TO and survival.</p><p><strong>Results: </strong>Of 236 patients included in this study, 106 (44.91%) achieved TO. TO was achieved in 71 cases after MIE (n=71 (41.21%)) and 31 after RAMIE (n=31 (57.41%)(p=0.036). RAMIE was associated with achievement of TO (OR: 2.01; 95% CI: 1.07-3.80; p=0.031) in the overall cohort. Achievement of TO was due to a reduction in major complications in the RAMIE group. Patients with perioperative TO had a higher 3 year disease-free survival (DFS) rate and overall survival rate (UV: HR 2.49, 95% CI: 1.18-5.26, p=0.016; MV: HR 4.30, 95% CI: 1.60-11.55, p=0.004) compared to those without perioperative TO and disease-free survival (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) after 2 year follow up.</p><p><strong>Conclusions: </strong>RAMIE is associated with an increased TO achievement. Achieving TO is associated with enhanced long-term survival in esophageal cancer patients and warrants continued emphasis on surgical quality improvement.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9000,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Textbook Outcome after Robotic and Laparoscopic Ivor Lewis Esophagectomy is Associated with Improved Survival - A Propensity Score Matched Analysis.\",\"authors\":\"Philippa Seika, Max M Maurer, Axel Winter, Ramin Raul Ossami-Saidy, Armanda Serwah, Paul V Ritschl, Jonas Raakow, Eva Dobrindt, Annika Kurreck, Johann Pratschke, Matthias Biebl, Christian Denecke\",\"doi\":\"10.1016/j.jtcvs.2024.11.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Esophagectomy is central to curative therapy for esophageal cancer (EC). Perioperative outcomes affect both disease-free and overall survival in oncological esophageal surgery. The adoption of robotic techniques may improve surgical outcome. However, the complex nature of perioperative outcomes is not adequately captured by individual quality measures.</p><p><strong>Methods: </strong>All patients after minimally invasive esophagectomy (MIE) or robotic-assisted MIE (RAMIE) junction between 2015 and 2022 were included. Textbook outcome was defined as negative resection margins (R0), retrieval of >20 lymph nodes, no major complications, reinterventions, ICU readmission, 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 while multivariate Cox proportional-hazards model was used to evaluate TO and survival.</p><p><strong>Results: </strong>Of 236 patients included in this study, 106 (44.91%) achieved TO. TO was achieved in 71 cases after MIE (n=71 (41.21%)) and 31 after RAMIE (n=31 (57.41%)(p=0.036). RAMIE was associated with achievement of TO (OR: 2.01; 95% CI: 1.07-3.80; p=0.031) in the overall cohort. Achievement of TO was due to a reduction in major complications in the RAMIE group. Patients with perioperative TO had a higher 3 year disease-free survival (DFS) rate and overall survival rate (UV: HR 2.49, 95% CI: 1.18-5.26, p=0.016; MV: HR 4.30, 95% CI: 1.60-11.55, p=0.004) compared to those without perioperative TO and disease-free survival (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) after 2 year follow up.</p><p><strong>Conclusions: </strong>RAMIE is associated with an increased TO achievement. Achieving TO is associated with enhanced long-term survival in esophageal cancer patients and warrants continued emphasis on surgical quality improvement.</p>\",\"PeriodicalId\":49975,\"journal\":{\"name\":\"Journal of Thoracic and Cardiovascular Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2024-11-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Thoracic and Cardiovascular Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jtcvs.2024.11.008\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Thoracic and Cardiovascular Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jtcvs.2024.11.008","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Textbook Outcome after Robotic and Laparoscopic Ivor Lewis Esophagectomy is Associated with Improved Survival - A Propensity Score Matched Analysis.
Background: Esophagectomy is central to curative therapy for esophageal cancer (EC). Perioperative outcomes affect both disease-free and overall survival in oncological esophageal surgery. The adoption of robotic techniques may improve surgical outcome. However, the complex nature of perioperative outcomes is not adequately captured by individual quality measures.
Methods: All patients after minimally invasive esophagectomy (MIE) or robotic-assisted MIE (RAMIE) junction between 2015 and 2022 were included. Textbook outcome was defined as negative resection margins (R0), retrieval of >20 lymph nodes, no major complications, reinterventions, ICU readmission, 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 while 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 cases after MIE (n=71 (41.21%)) and 31 after RAMIE (n=31 (57.41%)(p=0.036). RAMIE was associated with achievement of TO (OR: 2.01; 95% CI: 1.07-3.80; p=0.031) in the overall cohort. Achievement of TO was due to a reduction in major complications in the RAMIE group. Patients with perioperative TO had a higher 3 year disease-free survival (DFS) rate and overall survival rate (UV: HR 2.49, 95% CI: 1.18-5.26, p=0.016; MV: HR 4.30, 95% CI: 1.60-11.55, p=0.004) compared to those without perioperative TO and disease-free survival (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) after 2 year follow up.
Conclusions: RAMIE is associated with an increased TO achievement. Achieving TO is associated with enhanced long-term survival in esophageal cancer patients and warrants continued emphasis on surgical quality improvement.
期刊介绍：
The Journal of Thoracic and Cardiovascular Surgery presents original, peer-reviewed articles on diseases of the heart, great vessels, lungs and thorax with emphasis on surgical interventions. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the Journal focuses on techniques and developments in acquired cardiac surgery, congenital cardiac repair, thoracic procedures, heart and lung transplantation, mechanical circulatory support and other procedures.
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