经口达芬奇机器人手术治疗口咽鳞状细胞癌的效果

Therapeutic efficacy of transoral robotic surgery with the da Vinci robot system for the treatment of oropharyngeal squamous cell carcinoma

目的评估经口达芬奇机器人手术(TORS)治疗口咽鳞状细胞癌(OPSCC)的效果。方法采用混合设计队列研究方法,前瞻性收集并分析2020年7月至2023年2月在复旦大学附属眼耳鼻喉科医院接受TORS治疗的OPSCC患者临床资料(TORS组),2016年1月至2020年12月接受传统术式的OPSCC患者作为对照组。比较两组患者的基线资料、并发症发生情况及随访结果。结果共纳入166例患者,其中TORS组102例,男81例,女21例,年龄(59.1±9.8)岁;对照组64例,男54例,女10例,年龄(57.6±9.7)岁。TORS组术后出血发生率[2.9%(3/102)比10.9%(7/64),P=0.035]和术后感染发生率[1.0%(1/102)比18.8%(12/64),P<0.001]均低于对照组;而气管切开率[46.1%(47/102)比59.4%(38/64),P=0.070]和住院时间M(Q_(1),Q_(3))[8(7,10)d比10(4,12)d,P=0.088]两组差异均无统计学意义。经倾向性评分匹配后,与对照组相比,TORS组术后感染率较低[0(0/31)比19.4%(6/31),P=0.032],住院时间较短[7(7,10)d比10(8,12)d,P=0.031];TORS组与对照组术后出血发生率[3.2%(1/31)比6.5%(2/31),P=1.000]和气管切开率[22.6%(7/31)比45.2%(14/31),P=0.060]差异均无统计学意义。TORS组1年和2年无病生存率分别为96.3%和94.6%,对照组分别为90.6%和84.3%,两组比较差异无统计学意义(P=0.233)。TORS组1年和2年肿瘤特异生存率均为100%,对照组分别为96.9%和93.8%,两组比较差异无统计学意义(P=0.539)。结论TORS对OPSCC具有较高的临床安全性和较好的临床肿瘤学疗效。

Objective To evaluate the clinical efficacy of transoral robotic surgery(TORS)with the da Vinci robot system in the treatment of oropharyngeal squamous cell carcinoma(OPSCC).Methods A mixed cohort study was conducted to collect and analyze the clinical data of OPSCC patients who underwent TORS at the Eye&ENT Hospital,Fudan University between July 2020 and February 2023(TORS group).OPSCC patients who underwent conventional surgery between January 2016 and September 2020 were included as the control group.The baseline information,incidence of complications and follow-up data were compared between the two groups.Results A total of 166 patients were included,with 102 cases(81 males and 21 females)in the TORS group[mean age:(59.1±9.8)years]and 64 cases(54 males and 10 females)in the control group[mean age:(57.6±9.7)years].Compared with the control group,the TORS group had lower postoperative bleeding rate[2.9%(3/102)vs 10.9%(7/64),P=0.035]and infection rate[1.0%(1/102)vs 18.8%(12/64),P<0.001].No statistically significant differences were observed in tracheotomy rate[46.1%(47/102)vs 59.4%(38/64),P=0.070]and median length of hospital stay[8(7,10)d vs 10(4,12)d,P=0.088].After propensity score matching,compared with the control group,the TORS group had lower postoperative infection rate[0(0/31)vs 19.4%(6/31),P=0.032]and median length of hospital stay[7(7,10)d vs 10(8,12)d,P=0.031].No statistically significant differences were found in postoperative bleeding rate[3.2%(1/31)vs 6.5%(2/31),P=1.000]and tracheotomy rate[22.6%(7/31)vs 45.2%(14/31),P=0.060]between the two groups.Moreover,1-and 2-year disease-free survival rates were 96.3%and 94.6%in the TORS group,and 90.6%and 84.3%in the control group,respectively(P=0.233).The 1-and 2-year cancer-specific survival rates were both 100%in the TORS group,and 96.9%and 93.8%in the control group,respectively(P=0.539).Conclusion TORS for OPSCC is associated with high clinical safety and favorable oncological outcomes.