机器人和腹腔镜Ivor Lewis食道切除术后的教科书结果与改善的生存率有关:一种倾向性得分匹配分析
Philippa Seika1, Max M Maurer2, Axel Winter3
1Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
The Journal of thoracic and cardiovascular surgery
|November 18, 2024
概括
机器人辅助的最小侵入性食道切除术 (RAMIE) 改善了食道癌 (EC) 患者的教科书结局,导致更好的长期生存. 持续关注外科手术质量对于改善患者结果至关重要.
科学领域:
- 在瘤学瘤学.
- 手术创新 在外科创新.
- 改善医疗质量 改善医疗质量
背景情况:
- 食道切除术是食道癌 (EC) 的关键治疗方法.
- 术后的结果显著影响瘤食道手术后的存活率.
- 机器人技术可以提高手术结果,但全面的结果评估是复杂的.
研究的目的:
- 评估机器人辅助的微创食道切除术 (RAMIE) 与在EC患者中实现教科书结局 (TO) 之间的关联.
- 确定TO对长期无疾病生存率 (DFS) 和整体生存率 (OS) 的影响.
主要方法:
- 对236名EC患者进行微创食道切除术 (MIE) 或RAMIE (2015-2022) 的回顾性分析.
- 教科书结局 (TO) 定义为R0切除,≥20个淋巴结,没有重大并发症,重新干预,ICU再入院,30天死亡率/再入院率和 <21天住院时间.
- 倾向性得分匹配和多变量考克斯比例危险模型用于评估TO和生存率.
主要成果:
- 106名患者 (44.91%) 达到TO;RAMIE组的TO率 (57.41%) 与MIE (41.21%) (P=.036) 相比较高.
- 拉米与增加TO成就相关 (OR2.01,P=.031),主要是由于减少了主要并发症.
- 与没有TO的患者相比,获得TO的患者在3年内显著提高了DFS和OS率.
结论:
- 机器人辅助的最小侵入性食道切除术 (RAMIE) 与食道癌手术中教科书成果的改善相关.
- 实现教科书结果显著提高了EC患者的长期存活率.
- 强调改善外科手术质量,特别是使用机器人方法,对于优化患者的治疗结果至关重要.
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