机器人食管切除术趋势和早期手术结果：美国经验

SCI22 December 2022

Robotic esophagectomy trends and early surgical outcomes: The US experience

 (ATS, IF: 5.102)

Khaitan PG, Vekstein AM, Thibault D, et al. Robotic esophagectomy trends and early surgical outcomes: The US experience. Ann Thorac Surg 2022.

BACKGROUND 背景  

Recent esophagectomy trends were evaluated to describe the shift in surgical approach and outcomes using the Society of Thoracic Surgeons General Thoracic Surgery Database (STS-GTSD). 

使用胸外科医生协会胸外科数据库(STS-GTSD)评估最近食管癌切除术的趋势，以描述手术方法和结果的转变。

METHODS 方法

All patients who underwent an esophagectomy with gastric conduit were identified from 2015-2019 and analyzed according to original intended approach. After performing volume trend analysis of patients, operative outcomes were evaluated. 

选取2015-2019年所有行胃导管食管切除术的患者，按原拟入路进行分析。对患者进行大量趋势分析后，评估手术效果。

RESULTS 结果

Among 10,607 patients, esophagectomy was open in 5763 (54.3%), minimally-invasive (MIE) in 3524 (33.2%) and robotic (RAMIE) in 1320 (12.4%). Within five years, MIE and RAMIE combined rose to majority approach (open from 58 to 42% of annual volume). While MIE and RAMIE were associated with higher rates of anastomotic leak, loss of conduit, pulmonary embolus, and reoperation, R0 resection and harvested number of lymph nodes exceeded those in open approaches. Operative mortality did not differ by approach (3.21% open vs. 2.72% MIE vs. 2.50% RAMIE; p=0.2329). On multivariable analysis, RAMIE was independently associated with higher rate of anastomotic leak compared to open (aOR 1.53, 95% CI 1.14-2.04), while both MIE and RAMIE had lower mean length of stay. Propensity matching of 1,320 pairs found a higher risk of anastomotic leak requiring surgery for RAMIE compared to MIE (aOR 1.39, 95% CI 1.01-1.92). 

在10607例患者中，开放式食管切除术5763例(54.3%)，微创(MIE) 3524例(33.2%)，机器人(RAMIE) 1320例(12.4%)。在五年内，MIE和RAMIE加在一起上升到多数(开放式从年手术量的58%下降到42%)。MIE和RAMIE与更高的吻合口漏、导管丢失、肺栓塞和再手术发生率相关，但R0切除和收获的淋巴结数量高于开放入路。不同入路手术死亡率无差异(开放性3.21% vs MIE 2.72% vs RAMIE 2.50%;p = 0.2329)。在多变量分析中，与开放相比，RAMIE与更高的吻合口泄漏率独立相关(aOR 1.53, 95% CI 1.14-2.04)，而MIE和RAMIE的平均住院时间都较短。1320对倾向匹配发现，与MIE相比，RAMIE需要手术的吻合口泄漏风险更高(aOR 1.39, 95% CI 1.01-1.92)。

CONCLUSIONS 结论

In less than a decade, the dominant surgical approach in the STS-GTSD has become minimally invasive (RAMIE and MIE). While anastomotic leak and reoperation, more common in RAMIE, require a technical solution, these complications have not raised operative mortality. Further studies are needed to address long-term results and oncologic outcome.

在不到十年的时间里，STS-GTSD的主要手术方式已经变成了微创(RAMIE和MIE)。虽然在RAMIE中更常见的吻合口漏和再手术需要技术解决，但这些并发症并没有提高手术死亡率。需要进一步的研究来解决长期结果和肿瘤预后。

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