达芬奇机器人辅助McKeown食管癌切除术的临床应用及疗效评估

Clinical Application and Efficacy Evaluation of Da Vinci Robot⁃Assisted Mckeown Esophagectomy for Esophageal Cancer

目的:探讨达芬奇机器人辅助McKeown食管癌切除术的临床应用,评估其安全性、疗效和预后。方法:回顾性收集2016年8月至2021年12月在福建医科大学附属协和医院胸外科行达芬奇机器人辅助McKeown食管癌切除术患者的临床资料,采用统计学方法分析机器人辅助McKeown食管癌切除术的临床疗效、安全性及肿瘤预后情况。结果:共纳入151例采用达芬奇机器人辅助McKeown手术治疗的食管癌患者。患者的年龄为(62.49±8.64)岁,包括106例男性和45例女性。手术时间(282.43±69.61)min,失血量(108.01±74.40)mL,淋巴结清扫(40.21±17.40)个,其中胸部淋巴结清扫(21.47±9.69)个。左喉返神经旁淋巴结转移18例(11.92%),右喉返神经旁淋巴结转移30例(19.87%)。术后病理证实鳞癌患者149例、小细胞癌1例、小细胞混合鳞癌1例。在接受新辅助治疗的42例患者中,7例(16.67%)获得病理完全缓解。术后总体并发症发生率为32.45%(49/151),包括声嘶12例(7.95%)、肺部并发症29例(19.21%)、吻合口瘘6例(3.97%)、胸腔积液8例(5.30%)、切口感染1例(0.66%)、乳糜胸1例(0.66%)、心脏相关并发症13例(8.61%)。3名患者术后入住ICU,住院时间范围为7~15天。围手术期无死亡病例,术后住院时间(8.85±5.85)天。151例食管癌患者中,R0切除率为98.68%,5年无病生存率为63.9%,5年总生存率为69.1%。结论:达芬奇机器人辅助McKeown食管癌切除术是一种安全且有效的治疗方法,为食管癌患者提供了较好的临床疗效和预后。

Objective:The purpose of this study was to investigate the clinical application of da Vinci robot⁃assisted McKeown esophagectomy for esophageal cancer,and evaluate its safety,efficacy and prognosis.Methods:This study retro⁃spectively collected the clinical data of 151 patients who underwent da Vinci robot⁃assisted McKeown esophagectomy for e⁃sophageal cancer in the department of thoracic surgery in Union Hospital Affiliated to Fujian Medical University from August2016 to December 2021, and analyzed the clinical efficacy, safety, and tumor prognosis of robotic McKeown esophagectomyusing statistical methods. Results: A total of 151 patients with esophageal cancer treated with da Vinci robot⁃assisted McKe⁃own surgery were included. There were 106 men and 45 women, with the mean age of (62. 49 ±8. 64) years. The operationtime was (282. 43 ±69. 61) min;blood loss was (108. 01 ±74. 40) mL;and 40. 21 ±17. 40 lymph nodes were dissected,including 21. 47 ±9. 69 thoracic lymph nodes. There were 18 cases (11. 9%) of lymph node metastasis next to the left re⁃current laryngeal nerve, and 30 cases (19. 9%) of lymph node metastasis next to the right recurrent laryngeal nerve. Postop⁃erative pathology confirmed 149 patients with squamous carcinoma, 1 with small cell carcinoma, and 1 with mixed small cellsquamous carcinoma. Of the 42 patients who received neoadjuvant therapy, 7 (16. 67%) achieved pathological complete re⁃mission. The overall postoperative complication rate was 32. 45% (49/151). The complications included hoarseness in 12cases (7. 95%), pulmonary complications in 29 cases (19. 21%), anastomotic fistula in 6 cases (3. 97%), pleural effu⁃sion in 8 cases (5. 30%), incisional infection in 1 case (0. 66%), celiac disease in 1 case (0. 66%), and heart⁃relatedcomplications in 13 cases (8. 61%). 3 patients required admission to ICU postoperatively, with the length of stay from 7 to15 days. There were no deaths during the perioperative period, and the postoperative length of stay was (8. 85 ±5. 85) d.For the 151 patients with esophageal cancer, the R0 resection rate was 98. 68%, the 5⁃year disease⁃free survival was63. 9%, and the 5⁃year overall survival was 69. 1%. Conclusion: Da Vinci robot⁃assisted McKeown esophagectomy for e⁃sophageal cancer is a safe and effective treatment that provides better clinical outcomes and prognosis for patients with esoph⁃ageal cancer.