机器人辅助食管癌根治术的近期手术结果

Short-term outcomes of robot-assisted esophagectomy

目的回顾国内最大的一组单中心达芬奇机器人辅助下食管癌治疗结果，报道早期手术结果和相关技术学习曲线。方法回顾上海市胸科医院自2015年11月至2017年4月开展的所有机器人辅助食管癌根治术患者，共154例。研究内容包括患者的一般资料、肿瘤病理分期、手术过程、肿瘤切除结果和术后恢复情况。结果154例机器人辅助食管癌根治术患者中，男122例，女32例。全组患者均采用右胸一左颈一腹部三切口手术进路，均接受扩大胸腹二野淋巴结清扫。手术时间179～445（271．0±61．5）min，其中胸部手术时间51～142（96．7±27．0）min，术中出血量100～1000（230．4±74．4）ml。术后病理结果显示：鳞癌150例、腺癌2例、小细胞癌2例。R0切除率92．2％。淋巴结清扫11-64（20．4±8．5）枚，其中左、右喉返神经旁淋巴结采样率达92．2％和88．3％。术后并发症发生率41．6％，其中主要并发症如吻合口瘘发生率12．3％，单侧喉返神经损伤发生率16．9％。ICU住院时间为0～27（2．7±3．6）d，住院时间为7～81（15．8±11．6）d。无围术期死亡病例。结论机器人辅助食管癌根治术对于治疗食管癌是安全可行的，且对于喉返神经旁淋巴结的清扫更彻底。

Objective To investigate our early results of robot-assisted esophagectomy （RAE） and present our learning curve experience with the largest study from one-single institution of China. Methods Between November 2015 and April 2017, a series of consecutive patients undergoing RAE at Shanghai Chest Hospital were reviewed. The patients＇demographics, operative and postoperative outcmncs were demonstra- ted. Results A total of 154 patients underwent RAE during the study. All patients received Mckeown esophagectomy and extensive thoraco-abdominal two-field lymph node dissection. Of these, 122 were male and 32 were female. The mean total operative duration was 179 -445 （271.0±61.5） min and the opera- tive duration of the thoracic phase was 51 - 142 （96.7±27.0）rain. The mean estimated blood loss was 100 - 1 000 （230.4±74.4）ml. The pathological results showed that 150 had squamous cell carcinoma, 2 had adenocarcinoma, and 2 had small cell carcinoma. The R0 resection was 92. 2%. The mean number of lymph node dissection was 11 - 64 （ 20. 4±8.5 ） and the lymph node sampling rate along left and right recurrent laryngeal nerve （RLN） were 92.2% and 88.3%. The morbidity was present in 64 of 154 patients （41.6%）. The major complications rate was anastomotic leak （12. 3% ）, and vocal cord paralysis （ 16.9% ）. Intensive care unit （ICU） hospital stay time was 0 - 27 （2. 7±3.6） d, the median length of hospital stay was 7 - 81 （ 15.8±11.6 ） days. There was no 90-day mortality. Conclusions RAE is a safe and feasible alternative for treatment of esophageal cancer. RAE can improve the efficacy of lymph node dissection, especially for the lymphadenectomy along recurrent laryngeal nerve.