机器人辅助与视频辅助胸腔镜食道切除术多中心随机临床试验 (REVATE试验)
Yin-Kai Chao1, Zhigang Li2, Hongjing Jiang3
1Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan.
The British journal of surgery
|July 3, 2024
概括
机器人辅助食道切除术 (RAO) 与视频辅助胸腔镜式食道切除术 (VAO) 相比,在用于食道癌的左侧复发性喉神经淋巴结解剖方面取得了更好的成功. 此外,RAO还显著降低了短期和永久的声带的风险.
科学领域:
- 手术瘤学手术瘤学
- 胸部外科手术 胸部外科手术
- 最少侵入性的手术
背景情况:
- 胃肠状细胞癌的手术需要在复发性喉神经附近细致的淋巴结剖析.
- 在此过程中,喉神经的重复损伤会导致声带,增加肺部并发症的风险.
- 对比机器人辅助食道切除术 (RAO) 和视频辅助胸腔镜食道切除术 (VAO) 对于左侧复发性喉神经淋巴结剖析至关重要,对于患者的安全和手术结果至关重要.
研究的目的:
- 为了比较机器人辅助食道切除术 (RAO) 与视频辅助胸腔镜食道切除术 (VAO) 的疗效和安全性.
- 评估患有食道状细胞癌的患者左侧复发性喉神经淋巴结解剖的成功率.
主要方法:
- 一项随机对照试验,涉及患有食道状细胞癌的患者,接受微创性麦克恩食道切除术.
- 患者被随机分配到RAO或VAO,按临床中心分层.
- 主要终点是成功的左复发性喉神经淋巴结解剖,定义为至少一个淋巴结的去除,而无神经损伤持续超过6个月.
主要成果:
- 机器人辅助食道切除术 (RAO) 显示,相对于视频辅助胸腔镜食道切除术 (VAO) (69%;P<0.001),左喉神经复发性淋巴结解剖的成功率显著更高 (88.3%).
- RAO导致短期 (20.4%与34%相比; P = 0.029) 和永久 (5.8%与20%; P = 0.003) 复发性喉神经麻的发病率较低.
- 在RAO组中剖析了更多的中淋巴结 (中位数为16对14;P = 0.035),整体术后并发症率相似.
结论:
- 机器人辅助食道切除术 (RAO) 比视频辅助胸腔镜食道切除术 (VAO) 更有效,用于食道状细胞癌中左侧复发性喉神经淋巴结解剖.
- 在减少短期和长期的喉神经复发性损伤方面,RAO具有显著的优势.
- 该研究注册号为NCT03713749,支持RAO作为这种特定的手术剖析的更安全,更成功的方法.
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