机器人对比传统微创食管切除术治疗新辅助治疗后可切除食管癌：一项双中心回顾性研究
Robotic versus Conventional Minimally Invasive Esophagectomy for Resectable Esophageal Cancer After Neoadjuvant Therapy: A Dual-Center Retrospective Study.
文献信息
| PMID | 42860495 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Tianzheng Shen |
| 作者单位 | Department of Thoracic Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital, Shanghai, China. |
| 期刊 | Annals of surgical oncology |
| SCI 分区 | Q1 |
| IF | 3.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 关于新辅助治疗后，尤其是新辅助免疫放化疗后机器人辅助微创食管切除术（RAMIE）的数据仍然很少。本研究比较了可切除食管癌患者在新辅助治疗后接受RAMIE与传统微创食管切除术（MIE）的围手术期结局。
方法： 我们开展了一项双中心回顾性研究，连续纳入2020年至2025年间在新辅助放化疗或新辅助免疫放化疗后接受MIE的食管癌患者。基于术前变量进行倾向性评分匹配。分析围手术期结局。
结果： 经过1:1倾向性评分匹配后，每组分配137例患者。RAMIE组表现出更高的左喉返神经淋巴结清扫率（67.9% vs. 53.3%，p=0.02），并在新辅助放化疗后在该站获取更多淋巴结（平均1.6 vs. 1.0，p=0.02）。然而，RAMIE与更高的术后并发症总体发生率相关（38.0% vs. 24.8%，p=0.03）。在手术时间、病理完全缓解率、严重并发症、住院时间、30天再入院或90天死亡率方面未观察到显著差异。
结论： 在专家手中，RAMIE在新辅助治疗后实现了与MIE相当的围手术期安全性，并具有更优的清扫关键淋巴结站的能力。这一技术优势确立了RAMIE作为一种可行且有前景的手术选择，值得在随机试验中进一步前瞻性研究。
英文摘要
OBJECTIVES: Data on robot-assisted minimally invasive esophagectomy (RAMIE) after neoadjuvant therapy, particularly after neoadjuvant immunochemoradiotherapy, remain scarce. This study compares the perioperative outcomes of RAMIE versus conventional minimally invasive esophagectomy (MIE) in patients with resectable esophageal cancer after neoadjuvant therapy.
METHODS: We conducted a dual-center, retrospective study of consecutive patients with esophageal cancer who underwent MIE after neoadjuvant chemoradiotherapy or neoadjuvant immunochemoradiotherapy between 2020 and 2025. Propensity score matching was applied based on preoperative variables. Perioperative outcomes were analyzed.
RESULTS: After 1:1 propensity score matching, 137 patients were allocated to each group. The RAMIE group demonstrated a higher rate of left recurrent laryngeal nerve lymph node dissection (67.9% vs. 53.3%, p = 0.02) and yielded more lymph nodes in this station after neoadjuvant chemoradiotherapy (mean 1.6 vs. 1.0, p = 0.02). However, RAMIE was associated with a higher overall incidence of postoperative complications (38.0% vs. 24.8%, p = 0.03). No significant differences were observed in operation time, pathological complete response rate, severe complications, length of stay, 30-day readmission, or 90-day mortality.
CONCLUSIONS: In expert hands, RAMIE achieves perioperative safety comparable to that with MIE after neoadjuvant therapy and offers a superior ability to dissect critical lymph node stations. This technical advantage establishes RAMIE as a viable and promising surgical option, warranting further prospective investigation in randomized trials.