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中华胸部外科电子杂志 ›› 2019, Vol. 06 ›› Issue (01) : 37 -45. doi: 10.3877/cma.j.issn.2095-8773.2019.01.010

所属专题: 机器人专题 机器人手术 文献

机器人辅助微创食管切除术·综述

机器人辅助微创食管切除术的早期肿瘤学控制结果
张晓彬1, 郭旭峰1, 李斌1, 杨洋1, 茅腾1, 孙益峰1, 李志刚1,()   
  1. 1. 200030 上海交通大学附属胸科医院胸外科 上海交通大学食管疾病诊治中心
  • 收稿日期:2018-12-26 出版日期:2019-02-28
  • 通信作者: 李志刚

Early oncologic results of robot-assisted minimally invasive esophagectomy for esophageal cancer

Xiaobing Zhang1, Xufeng Guo1, bin Li1, Yang Yang1, Teng Mao1, Yifeng Sun1, Zhigang Li1,()   

  1. 1. Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
  • Received:2018-12-26 Published:2019-02-28
  • Corresponding author: Zhigang Li
  • About author:
    Corresponding author: Li Zhigang, Email:
引用本文:

张晓彬, 郭旭峰, 李斌, 杨洋, 茅腾, 孙益峰, 李志刚. 机器人辅助微创食管切除术的早期肿瘤学控制结果[J/OL]. 中华胸部外科电子杂志, 2019, 06(01): 37-45.

Xiaobing Zhang, Xufeng Guo, bin Li, Yang Yang, Teng Mao, Yifeng Sun, Zhigang Li. Early oncologic results of robot-assisted minimally invasive esophagectomy for esophageal cancer[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2019, 06(01): 37-45.

自21世纪机器人辅助微创食管癌切除术(RAMIE)首次被报道应用于临床,该项术式近20年来在全球得到了广泛推广。尽管RAMIE尚未被广泛认为是食管癌外科治疗的标准手术方式,已有多家中心报道了经裂孔和经胸路径RAMIE的安全性和可行性。多数研究报道的重点主要围绕围术期结果和近期肿瘤学结果。R0切除率接近95%并且局域复发率较低,提示RAMIE可能提高食管癌患者的远期生存率。该文拟结合既往文献报道和本中心经验,报道RAMIE的早期肿瘤学控制结果。

Since the first reported clinical application of robot-assisted minimally invasive esophagectomy (RAMIE) in the early 2000s, RAE has gained increasing popularity worldwide in the recent 20 years. Although RAE is not yet regarded as standard surgical treatment for esophageal cancer, a lot of institutions have reported the safety and feasibility of robotic system in both transhiatal esophagectomy (THE) and transthoracic esophagectomy (TTE). Most of the studies focused on the surgical outcomes and recent oncologic results, the RAMIE have shown with short blood loss and effective early oncologic outcomes: R0 resection rate approximately 95% and rare locoregional recurrence. This may show that RAMIE has a tendency of improved long-term survival for esophageal cancer. Thus, the objective of this study is to report the early oncological control results of robot assisted esophagectomy, based on the previous publications and our initial experience.

表1 机器人辅助食管癌根治术(RAMIE)的肿瘤学结果文献汇总
作者 发表时间(年) n 手术路径 肿瘤类型(n) 病理分期(n) R0切除[n (%)] 中位随访期(月) 复发[(n (%)] 中位DFS(月) 中位OS(月) 存活率
Kernstine等[15] 2007 14 TT (McKeown) SCC (4)AD (8)
HGD (2)
HGD (2) 14 (100) 9 3 (21) 未报道 未报道 未报道
Ⅱa (1)
Ⅱb (2)
Ⅲ(7)
Ⅳ(2)
Galvani等[16] 2007 18 TH HGD (9)
AD (9)
HGD (9) 未报道 22 3 (17) 未报道 未报道 未报道
0 (2)
Ⅰ (5)
Ⅱa (2)
Boone等[17] 2009 47 TT (McKeown) SCC (18)
AD (29)
Ⅰ (2) 36 (77) 35 30 (64) 15 未报道 未报道
Ⅱa (6)
Ⅱb (3)
Ⅲ (8)
Ⅳ (28)
Dunn等[18] 2013 40 TH SCC (2)
AD (36)
疗效[n(%)] 36 (95) 29 16 (44) 20 未报道 未报道
完全有效5 (13.2)
ⅠA 10 (26.3)
ⅠB 6 (15.8)
ⅡA 1 (2.6)
ⅡB 7 (18.4)
ⅢA 3 (7.9)
ⅢB 4 (10.5)
Ⅳ 2 (5.3)
Coker等[19] 2014 23 TH AD (23) T0N0 7 (30) 21 (91) 7 6 (26) 未报道 未报道 未报道
T0N1 2 (9)
T1N0 4 (17)
T2N0 3 (13)
T2N1 1 (4)
T2N2 1 (4)
T3N0 2 (9)
T3N1 1 (4)
T3N2 1 (4)
T3N3 1 (4)
van der Sluis等[20] 2015 108 TT (McKeown) SCC (20)
AD (78)
无肿瘤(10)
病理T分期[n (%)] 102 (94) 58 51 (49%) 21 29 5年OS 42%
pT0 10 (9)
pT1 20 (19)
pT2 11 (10)
pT3 65 (60)
pT4a 2 (2)
病理N分期[n (%)]
pN0 48 (44)
pN1 30 (28)
pN2 20 (19)
pN3 10 (9)
Cerfolio等[21] 2015 85 TT (Ivor-Lewis) SCC (12) 未报道 84 (99) 27 未报道 未报道 未报道 1年73.1%
AD (72) 2年59.9%
HGD (1) 3年OS 54.2%
Wee JO等[22] 2016 20 TT (Ivor-Lewis) SCC (2)
AD (15)
HGD (1)
GIST (1)
失弛缓症(1)
完全缓解4 (20) 20 (100) 11 未报道 未报道 未报道 1年84%
T1-4N0M0 3 (15)
T1-4N1M0 8 (40)
T1-4N2M0 1 (5)
T1–4N3M0 1 (5)
其他3 (15)
Park S等[23] 2016 62 TT (McKeown) SCC ⅠA 10 (16.1) 未报道 17 未报道 未报道 未报道 5年OS 69%
ⅠB 24 (38.7)
ⅡA 4 (6.5)
ⅡB 15 (24.2)
ⅢA 6 (9.7)
ⅢB 2 (3.2)
ⅣC 1 (1.6)
Park S等[24] 2017 115 TT (McKeown) SCC Ⅰ 56 (50.5) 110 (95.7) 32 19 (17.1) 未报道 未报道 3年OS 85.0%
3年DFS 79.4%
Ⅱ 28 (25.2)
ⅢA 13 (11.7)
ⅢB + C 14 (12.6)
van der Horst S等[25] 2017 31 TT (McKeown) SCC (19)
AD (12)
T0N0 8 (25.8) 30 (96.8) 18 15 (48) 13 16 未报道
T0N1 2 (6.5)
T1N0 3 (9.7)
T1N1 2 (6.5)
T2N0 2 (6.5)
T2N1 1 (3.2)
T3N0 4 (12.9)
T3N1 2 (6.5)
T3N2 5 (16.1)
T3N3 1 (3.2)
T4aN3 1 (3.2)
Dunn等[26] 2017 98 TH SCC (6)
AD (92)
ⅠA 23 (28.0) 91 (97.8) 27 41 (42.7) 41 54 3年OS 57%
3年PFS 53%
ⅠB 15 (18.3)
ⅡA 4 (4.9)
ⅡB 17 (20.7)
ⅢA 16 (19.5)
ⅢB 2 (2.4)
Ⅳ 5 (6.1)
van der Sluis等[27] 2018 54 TT (McKeown) SCC (13)
AD (41)
pT0N0 10 (19) 50 (93) 40 未报道 26 未报道 未报道
pT0N1 6 (11)
pT1aN0 1 (2)
pT1aN1 1 (2)
pT1bN0 1 (2)
pT1bN1 3 (6)
pT1bN2 0 (0)
pT2N0 6 (11)
pT2N1 4 (7)
pT2N2 0 (0)
pT2N3 1 (2)
pT3N0 6 (11)
pT3N1 6 (11)
pT3N2 4 (7)
pT3N3 2 (4)
pT4aN1 0 (0)
pT4aN3 1 (2)
pT4b 2(4)
表2 206食管鳞癌患者的基本情况
表3 206例食管鳞癌患者近期手术结果
图1 206例食管鳞癌患者总体生存情况。A.总体生存率;B.分层分析-pTNM分期
图2 206例食管鳞癌患者无疾病生存情况。A.无疾病生存率;B.分层分析-pTNM分期
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