通过回顾国内最大的一组单中心达芬奇机器人辅助食管癌(RAE)手术治疗结果，报道上海市胸科医院RAE根治术的早期结果和相关技术学习曲线。

回顾上海市胸科医院自2015年11月至2016年8月开展的所有RAE患者，共75例。研究内容包括患者的一般资料、术前肿瘤病理分期、手术过程、肿瘤切除结果和术后恢复情况。

75例RAE患者中，男性53例，女性22例。平均年龄(62.1±8.0)岁。术前诱导4例(5.3%)，R0切除率73/75(97.3%)，平均出血量(230.7±73.5)ml。全组平均手术时间(275.2±56.8)min，胸部手术时间(95.6±27.5)min。最早20例与之后55例比较：全部手术时间分别为(318.0±48.1)min和(259.7±51.8)min(t＝ 4.391，P<0.001)；胸部手术时间分别为(115.1±29.0)min和(88.6±23.5)min(t＝ 4.057，P＝0.001)。平均切除淋巴结总数为(15.9±11.0)枚，切除胸部淋巴结个数为(9.8±6.9)枚，切除喉返神经旁淋巴结个数为(3.3±2.6)枚。以手术日期为分界，20例为组，对75例患者行亚分组后，上纵隔淋巴结采样率分别为85.0%、100.0%、100.0%和100.0%(χ²＝8.594，P＝0.049)，其中左喉返神经旁淋巴结采样率分别为65.0%、95.0%、95.0%和100.0%(χ²＝13.920，P＝0.006)。术后主要并发症包括呼吸功能不全5例(6.7%)、乳糜胸2例(2.7%)、气管食管瘘1例(1.3%)、肺栓塞1例(1.3%)、喉返神经麻痹(VCP)11例(14.7%)。以手术日期为界，25例为组，对75例患者行亚分组后发现，VCP发生率明显下降，但差异无统计学意义(24.0%、12.0%和8.0%；χ²＝2.770，P＝0.250)。患者中位住院时间12 d，无术后30 d内死亡病例。

RAE根治术安全、可靠。经过20例左右的学习曲线后，术者可熟练掌握胸部机器人手术操作和纵隔淋巴结清扫，尤其是双侧喉返神经旁可获得明显改善，而喉返神经损伤率也能明显降低。

To review the outcomes of robot-assisted esophagectomy (RAE) for esophageal cancer in Shanghai Chest Hospital, and present the learning curve experience.

The clinical data of 75 patients undergoing RAE for esophageal cancer between November 2015 and August 2016 in Shanghai Chest Hospital were reviewed. The demographics, preoperative staging, surgical procedure, resection results and postoperative outcomes were analyzed.

Among these 75 patients, 53 were males and the other 22 were females, with the mean age of (62.1±8.0)years. Preoperative induction took place in 4 patients(5.3%). The R0 resection rate was 97.3%(73/75). The mean volume of blood loss was (230.7±73.5) ml. The mean total operation time of all patients was (275.2±56.8) min, and the mean thoracic operation time was (95.6±27.5) min. The total operation time of the former 20 cases was significantly longer than that of the latter 55 cases[(318.0±48.1) min vs(259.7±51.8) min, t= 4.391, P<0.001]. The thoracic operation time of the former 20 cases was significantly longer than that of the latter 55 cases[(115.1±29.0) min vs(88.6±23.5) min, t= 4.057, P=0.001]. The mean number of lymph node dissection was 15.9±11.0, the number of thoracic lymph node dissection was 9.8±6.9, and the number of recurrent laryngeal nerve lymph node dissection was 3.3±2.6. When subgrouping according to operation sequencesof 1-20, 21-40, 41-60 and 61-75, the lymph node sampling rates of upper mediastinum were 85.0%, 100.0%, 100.0% and 100.0%, respectively(χ²=8.594, P=0.049), and the lymph node sampling rates along left recurrent laryngeal nerve were 65.0%, 95.0%, 95.0% and 100.0%, respectively(χ²=13.920, P=0.006). The main complications were respiratory failure(5 cases, 6.7%), chylothorax (2 cases, 2.7%), tracheo-esophageal fistula(1 case, 1.3%), pulmonary embolism(1 case, 1.3%) and vocal cord paralysis(VCP)(11 cases, 14.7%). When subgrouping according to operation sequencesof 1-25, 26-50 and 51-75, the incidence of VCP decreased without significant difference(24.0%, 12.0% and 8.0%; χ²=2.770, P=0.250). The median length of hospital stay was 12 d, and there was no 30-day mortality.

RAE is a safe and feasible alternative for treatment of esophageal cancer, which can improve the efficacy of lymph node dissection, especially for the lymphadenectomy along recurrent laryngeal nerve. The ability to execute a safe thoracicesophagectomy with complete mediastinal lymphadenectomy during RAE is improved over time, plateauing after the first 20 cases.