Background

Oncological esophageal surgery has evolved significantly in the last decades. From open esophagectomy over (hybrid) minimally invasive surgery, nowadays, robot-assisted minimally invasive esophagectomy (RAMIE) approaches are applied. Current techniques require an analysis of possible advantages and disadvantages indicating the direction towards a novel gold standard.

Methods

Robot-assisted Ivor Lewis esophagectomies, performed in the period from April 2017 to June 2019 in five German centers (Berlin, Cologne, Hamburg, Kiel, Mainz), were included in this study. Pre-, intra-, and postoperative parameters were assessed. Cases were grouped for hybrid (H-RAMIE) versus totally robot-assisted (T-RAMIE) approaches. Postoperative parameters and complications were compared using risk ratios.

Results

A total of 175 operations were performed as T-RAMIE and 67 as H-RAMIE. Patient age (median age 62 years) and sex (83.1% male) were similarly distributed in both groups. Median duration of esophagectomy was significantly lower in the T-RAMIE group (385 versus 427 min, p < 0.001). The risks of “overall morbidity” (32.0 versus 47.8%; risk ratio [RR], 95% confidence interval (CI): 1.5, 1.1–2.1; p = 0.026), “anastomotic leak” (10.3 versus 22.4%; RR, CI: 2.2, 1.2–4.1; p = 0.020), and “respiratory failure” (1.1 versus 7.5%; RR, CI: 6.5, 1.3–32.9; p = 0.019) were significantly higher in case of H-RAMIE.

Conclusions

In the five participating German centers, T-RAMIE was the preferred procedure (72.3% of operations). In comparison to H-RAMIE, T-RAMIE was associated with a significantly reduced risk of postoperative morbidity, anastomotic leak, and respiratory failure as well as a significantly reduced time necessary for esophagectomy.

中文翻译：

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机器人辅助微创食管切除术的多中心经验——混合和完全机器人辅助技术的比较

背景

在过去的几十年中，肿瘤食管外科手术取得了长足的发展。从开放食管切除术到（混合）微创手术，如今，机器人辅助微创食管切除术（RAMIE）方法得到应用。当前的技术需要对可能的优点和缺点进行分析，以表明朝着新的金标准发展的方向。

方法

本研究包括 2017 年 4 月至 2019 年 6 月期间在五个德国中心（柏林、科隆、汉堡、基尔、美因茨）进行的机器人辅助 Ivor Lewis 食管切除术。评估了术前、术中和术后参数。案例被分组为混合（H-RAMIE）与完全机器人辅助（T-RAMIE）方法。使用风险比比较术后参数和并发症。

结果

T-RAMIE 总共进行了 175 次操作，H-RAMIE 进行了 67 次操作。患者年龄（中位年龄 62 岁）和性别（83.1% 男性）在两组中的分布相似。T-RAMIE 组食管切除术的中位持续时间显着缩短（385 对 427 分钟，p < 0.001）。“总体发病率”的风险（32.0 对 47.8%；风险比 [RR]，95% 置信区间 (CI)：1.5, 1.1–2.1；p = 0.026），“吻合口漏”（10.3 对 22.4%；RR， CI：2.2, 1.2–4.1；p = 0.020）和“呼吸衰竭”（1.1 对 7.5%；RR，CI：6.5, 1.3–32.9；p = 0.019）在 H-RAMIE 的情况下显着更高。

结论

在五个参与的德国中心中，T-RAMIE 是首选手术（72.3% 的手术）。与 H-RAMIE 相比，T-RAMIE 与显着降低术后发病率、吻合口漏和呼吸衰竭的风险以及显着减少食管切除术所需的时间有关。