Annals of surgical oncology · 2025
Comparison of Short-Term Outcomes Between Robot-Assisted and Conventional Mediastinoscopic Esophagectomies: A Retrospective Study Using Propensity Score Matching.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Mitsui Takashi, Kawabata Hiroto, Hakozaki Yuhei, Saito Kazuyuki, Yagi Koichi, Okuyama Takashi, Yoshitomi Hideyuki
Аннотация
BACKGROUND: Mediastinoscopic esophagectomy (ME) is a minimally invasive surgery for esophageal cancer that avoids one-lung ventilation and chest wall trauma. However, a major challenge with this technique is the relatively high incidence of left recurrent laryngeal nerve palsy (RLNP). To address this, we introduced a transcervical mediastinoscopic and transabdominal robot-assisted esophagectomy (RA-ME) technique. The clinical significance of robotic assistance in ME was evaluated by comparing RA-ME and conventional ME (Co-ME), using propensity score matching (PSM) to control for baseline characteristics.
METHODS: We retrospectively reviewed patients who underwent ME for esophageal or esophagogastric junction cancer between April 2018 and March 2025. Patients were classified into RA-ME and Co-ME groups. PSM was performed using five covariates, resulting in 68 matched pairs (n = 136). The primary endpoint was the incidence of left RLNP, whereas secondary endpoints included operative time, blood loss, complications, lymph node yield, and R0 resection rate.
RESULTS: A total of 136 matched patients (RA-ME, n = 68; Co-ME, n = 68) were analyzed after PSM. The RA-ME group had a significantly lower RLNP incidence (19.1% vs 38.2%, p = 0.022) and less intraoperative blood loss than the Co-ME group (99.8 ± 116.1 mL vs 251.0 ± 821.1 mL, p = 0.001). Operative time, complication rates, lymph node yield, and R0 resection rates were comparable between the groups.
CONCLUSIONS: RA-ME significantly reduced RLNP incidence, nearly halving it, and lowered intraoperative blood loss without compromising oncologic quality. These findings support the potential use of RA-ME as a standard approach in select cases of minimally invasive esophageal cancer surgery.
METHODS: We retrospectively reviewed patients who underwent ME for esophageal or esophagogastric junction cancer between April 2018 and March 2025. Patients were classified into RA-ME and Co-ME groups. PSM was performed using five covariates, resulting in 68 matched pairs (n = 136). The primary endpoint was the incidence of left RLNP, whereas secondary endpoints included operative time, blood loss, complications, lymph node yield, and R0 resection rate.
RESULTS: A total of 136 matched patients (RA-ME, n = 68; Co-ME, n = 68) were analyzed after PSM. The RA-ME group had a significantly lower RLNP incidence (19.1% vs 38.2%, p = 0.022) and less intraoperative blood loss than the Co-ME group (99.8 ± 116.1 mL vs 251.0 ± 821.1 mL, p = 0.001). Operative time, complication rates, lymph node yield, and R0 resection rates were comparable between the groups.
CONCLUSIONS: RA-ME significantly reduced RLNP incidence, nearly halving it, and lowered intraoperative blood loss without compromising oncologic quality. These findings support the potential use of RA-ME as a standard approach in select cases of minimally invasive esophageal cancer surgery.