The Journal of thoracic and cardiovascular surgery · 2026
Longitudinal pulmonary function changes and pulmonary complications after robot-assisted thoracoscopic versus open transthoracic esophagectomy.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Jeon Yeong Jeong, Kang Danbee, Moon Sungmi, Lee Junghee, Cho Jong Ho, Kim Hong Kwan, Choi Yong Soo, Park Hye Yun, Park Seong Yong
Аннотация
OBJECTIVE: Esophagectomy is associated with significant postoperative pulmonary complications (PPCs), occurring in 20% to 50% of patients. Although robot-assisted thoracoscopic esophagectomy (RATE) is a promising alternative to open transthoracic esophagectomy (OTE), comprehensive data on longitudinal pulmonary function recovery and clinical outcomes remain limited. This study aimed to compare the changes in pulmonary function and PPCs between RATE and OTE over the first year after surgery.
METHODS: This retrospective cohort study was conducted at Samsung Medical Center, Seoul, South Korea, and included 1917 patients with esophageal cancer who underwent curative-intent esophagectomy and for whom pulmonary function test data were available. Of these, 1485 (77.5%) underwent OTE and 432 (22.5%) underwent RATE. Spirometry and diffusing capacity of the lung for carbon monoxide measurements were performed preoperatively and at 3, 6, and 12 months postoperatively. Linear mixed-effects models were used to analyze longitudinal changes, adjusting for age, sex, stage, and neoadjuvant therapy. Multivariable logistic regression was used to evaluate the association between surgical approach and PPCs.
RESULTS: Baseline pulmonary functions were similar for the groups, except for greater diffusing capacity of the lung for carbon monoxide in the RATE group (19.2 vs 17.7 mL/min/mm Hg, P < .001). RATE was associated with significantly better preservation of pulmonary function across all parameters. At 3 months, forced vital capacity (FVC, % predicted) decreased by 14.5% in the OTE group versus 6.1% in the RATE group and FEV1 (% predicted) by 11.5% versus 4.6%. By 12 months, FVC (% predicted) declined by 12.3% versus 3.8% and FEV1 (% predicted) by 7.3% versus 0.9%, respectively. The benefits were more pronounced in patients receiving neoadjuvant therapy, with FVC (% predicted) declining by 14.8% in the OTE group versus 3.3% in the RATE group at 3 months. PPCs occurred less frequently in the RATE group (28.8% vs 39.4%, P < .001). After comprehensive adjustment, RATE was associated with a 27% reduction in complication risk (adjusted odds ratio, 0.73; 95% CI, 0.57-0.93; P = .011), with consistent benefits observed in both upfront surgery and neoadjuvant therapy subgroups.
CONCLUSIONS: RATE can significantly better preserve pulmonary function and reduce PPCs compared with OTE throughout the first year after surgery, with the greatest benefits in the early postoperative period and for patients receiving neoadjuvant therapy. This supports the use of RATE as the preferred approach for appropriate candidates with esophageal cancer, particularly those at greater risk for PPC.
METHODS: This retrospective cohort study was conducted at Samsung Medical Center, Seoul, South Korea, and included 1917 patients with esophageal cancer who underwent curative-intent esophagectomy and for whom pulmonary function test data were available. Of these, 1485 (77.5%) underwent OTE and 432 (22.5%) underwent RATE. Spirometry and diffusing capacity of the lung for carbon monoxide measurements were performed preoperatively and at 3, 6, and 12 months postoperatively. Linear mixed-effects models were used to analyze longitudinal changes, adjusting for age, sex, stage, and neoadjuvant therapy. Multivariable logistic regression was used to evaluate the association between surgical approach and PPCs.
RESULTS: Baseline pulmonary functions were similar for the groups, except for greater diffusing capacity of the lung for carbon monoxide in the RATE group (19.2 vs 17.7 mL/min/mm Hg, P < .001). RATE was associated with significantly better preservation of pulmonary function across all parameters. At 3 months, forced vital capacity (FVC, % predicted) decreased by 14.5% in the OTE group versus 6.1% in the RATE group and FEV1 (% predicted) by 11.5% versus 4.6%. By 12 months, FVC (% predicted) declined by 12.3% versus 3.8% and FEV1 (% predicted) by 7.3% versus 0.9%, respectively. The benefits were more pronounced in patients receiving neoadjuvant therapy, with FVC (% predicted) declining by 14.8% in the OTE group versus 3.3% in the RATE group at 3 months. PPCs occurred less frequently in the RATE group (28.8% vs 39.4%, P < .001). After comprehensive adjustment, RATE was associated with a 27% reduction in complication risk (adjusted odds ratio, 0.73; 95% CI, 0.57-0.93; P = .011), with consistent benefits observed in both upfront surgery and neoadjuvant therapy subgroups.
CONCLUSIONS: RATE can significantly better preserve pulmonary function and reduce PPCs compared with OTE throughout the first year after surgery, with the greatest benefits in the early postoperative period and for patients receiving neoadjuvant therapy. This supports the use of RATE as the preferred approach for appropriate candidates with esophageal cancer, particularly those at greater risk for PPC.