Mohammad Al Azzawi, Orla Brett, Claire Coleman, Domhnall O'Connor, Mohammed Albagir, Jarlath C Bolger, William B Robb
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Operations were classified as open, hybrid, minimally invasive, RAS-hybrid, or totally RAS. Length of stay (LOS), margin status, nodal yield, perioperative complications, and mortality were compared, as well as ERAS outcomes, where applicable.</p><p><strong>Results: </strong>A total of 198 patients underwent oesophagectomy; 93 underwent RAS (52 total RAS, 41 hybrid). Demographics were comparable between RAS and non-RAS groups. There was an improvement in nodal yield for the total-RAS patients compared to non-RAS patients (mean 27.8, SD 8.7 vs 23.2, SD 9.1; p = 0.1). There was no difference in margin status (p = 0.55), overall complications (p = 0.23), LOS (p = 0.31), or 90-day mortality (p = 0.85) between RAS and non-RAS groups. The anastomotic leak rate was 3% for RAS versus 10% for non-RAS (p = 0.08). The chyle leak rate increased with RAS (22% vs 10%, p = 0.01), although this decrease was observed over time. R0 resection rate was comparable for RAS and non-RAS (90% vs 91% p = 0.55).</p><p><strong>Conclusions: </strong>RAS oesophagectomy can be introduced safely for experienced RAS surgeons. Early in the learning curve, similar perioperative outcomes occur, with no significant increase in overall complications. 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引用次数: 0
摘要
导读:食管癌的发病率正在上升,随着新辅助治疗和围手术期治疗的改善,食管癌切除术的发生率也在上升。食管癌切除术仍然是根治性治疗的基石。由于对学习曲线和安全性的担忧,机器人辅助手术(RAS)在食管癌切除术中的应用进展缓慢。本系列报道了在爱尔兰安全引入RAS进行食管切除术的情况。方法:对一名外科医生2016年2月至2024年12月期间的前瞻性数据进行回顾。提取标准临床病理变量。RAS项目(使用达芬奇X/Xi)于2020年3月开始进行食管切除术。手术分为开放式、混合式、微创式、RAS-混合式或完全RAS。比较住院时间(LOS)、切缘状态、淋巴结生成率、围手术期并发症和死亡率,以及ERAS结果(如适用)。结果:198例患者行食管切除术;93例行RAS(全RAS 52例,杂交41例)。RAS组和非RAS组的人口统计数据具有可比性。与非ras患者相比,ras患者的淋巴结生成量有所改善(平均27.8,SD 8.7 vs 23.2, SD 9.1; p = 0.1)。RAS组和非RAS组在切缘状态(p = 0.55)、总并发症(p = 0.23)、LOS (p = 0.31)和90天死亡率(p = 0.85)方面均无差异。吻合口漏率RAS组为3%,非RAS组为10% (p = 0.08)。乳糜漏率随RAS的增加而增加(22% vs 10%, p = 0.01),尽管随着时间的推移,乳糜漏率会下降。RAS和非RAS的R0切除率相当(90% vs 91% p = 0.55)。结论:经验丰富的RAS外科医生可以安全地进行RAS食管切除术。在学习曲线的早期,类似的围手术期结果发生,总体并发症没有显著增加。RAS具有改善肿瘤预后的潜力。
Quality and safety of Ireland's first robotic oesophagectomy program.
Introduction: Oesophageal cancer incidence is rising, with a concurrent increase in oesophagectomy as neoadjuvant and perioperative therapies improve. Oesophagectomy remains the cornerstone of curative treatment. The adoption of robotic-assisted surgery (RAS) in oesophagectomy has been slow, with concerns regarding the learning curve and safety. This series describes the safe introduction of RAS for oesophagectomy in Ireland.
Methods: A review of prospectively maintained data from a single surgeon was performed, encompassing the period from February 2016 to December 2024. Standard clinicopathological variables were extracted. The RAS program (using DaVinci X/Xi) for oesophagectomy began in March 2020. Operations were classified as open, hybrid, minimally invasive, RAS-hybrid, or totally RAS. Length of stay (LOS), margin status, nodal yield, perioperative complications, and mortality were compared, as well as ERAS outcomes, where applicable.
Results: A total of 198 patients underwent oesophagectomy; 93 underwent RAS (52 total RAS, 41 hybrid). Demographics were comparable between RAS and non-RAS groups. There was an improvement in nodal yield for the total-RAS patients compared to non-RAS patients (mean 27.8, SD 8.7 vs 23.2, SD 9.1; p = 0.1). There was no difference in margin status (p = 0.55), overall complications (p = 0.23), LOS (p = 0.31), or 90-day mortality (p = 0.85) between RAS and non-RAS groups. The anastomotic leak rate was 3% for RAS versus 10% for non-RAS (p = 0.08). The chyle leak rate increased with RAS (22% vs 10%, p = 0.01), although this decrease was observed over time. R0 resection rate was comparable for RAS and non-RAS (90% vs 91% p = 0.55).
Conclusions: RAS oesophagectomy can be introduced safely for experienced RAS surgeons. Early in the learning curve, similar perioperative outcomes occur, with no significant increase in overall complications. RAS has the potential to improve oncologic outcomes.
期刊介绍:
The Irish Journal of Medical Science is the official organ of the Royal Academy of Medicine in Ireland. Established in 1832, this quarterly journal is a contribution to medical science and an ideal forum for the younger medical/scientific professional to enter world literature and an ideal launching platform now, as in the past, for many a young research worker.
The primary role of both the Academy and IJMS is that of providing a forum for the exchange of scientific information and to promote academic discussion, so essential to scientific progress.