Abstract: Objective:To compare the clinical efficacy of Da Vinci robotassisted esophagectomy and combined thoracoscopy and laparoscopyassisted esophagectomy for esophageal cancer.
Methods:The retrospective cohort study was conducted. The clinicopathological data of 116 patients who underwent minimally invasive radical resection of esophageal cancer in the Shanghai Chest Hospital of Shanghai Jiaotong University between November 2015 and September 2016 were collected. Fiftyeight patients undergoing combined thoracoscopy and laparoscopyassisted esophagectomy and 58 undergoing Da Vinci robotassisted esophagectomy were respectively allocated into the thoracoscopy and laparoscopyassisted and Da Vinci robotassisted groups.Patients received esophagectomy by right thoraxleft cervicoabdominal triple incisions, thoraxcervico 2field lymph node dissection of esophageal cancer and digestive tract reconstruction via assisted incision. Observation indicators: (1) surgical and postoperative situations; (2) followup and survival situations. Followup using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence or metastasis up to March 2017. Measurement data with normal distribution were described as ±s. Measurement data with skewed distribution were described as M (range). Comparison between groups was analyzed by the nonparametric test, and comparisons of count data were done by the chisquare test and Fisher′s exact probability.
Results:(1) Surgical and postoperative situations: all patients received successful surgery, without conversion to open surgery. The number of lymph nodes dissected along the recurrent laryngeal nerve (RLN) and duration of postoperative hospital stay were 2.8±2.2, 13 days (range, 9-131 days) in the thoracoscopy and laparoscopyassisted group and 4.8±3.7, 11 days (range, 7-81 days) in the Da Vinci robotassisted group, respectively, with statistically significant differences between the 2 groups (t=3.480, Z=2.361, P<0.05). The total operation time, numbers of patients with overall complications, anastomotic leakage, injury of the RLN, pleural effusion, pulmonary infection, respiratory failure, chylothorax, arrhythmia and tracheoesophageal fistula were respectively (276±61)minutes, 24, 15, 7, 6, 5, 4, 2, 1, 0 in the thoracoscopy and laparoscopyassisted group and (261±50)minutes, 21, 8, 10, 4, 2, 2, 1, 1, 1 in the Da Vinci robotassisted group, with no statistically significant difference (t=1.296, X²=0.327, 2.657, 0.620, 0.438, 1.368, 0.703, 0.342, 1.009, P>0.05). Some of the patients had postoperative multiple complications. Patients with anastomotic leakage received local dressing changes, continuous gastrointestinal decompression and vacuum aspiration. The pronunciation and bucking response were observed in patients with injury of the RLN (unilateral injury). Patients with pleural effusion received pleural puncture fluid or closed thoracic drainage. Patients with pulmonary infection underwent antibiotic therapy and regular aerosol inhalation. Patients with respiratory failure underwent tracheotomy and assisted breathing with ventilator. Patients with chylothorax received fasting and closed thoracic drainage. Patients with arrhythmia were treated by drug. Patients with tracheoesophageal fistula underwent conservative treatment. All the patients with complications were improved or cured. There were no wound infection, deep venous thrombosis of lower extremity, pulmonary embolism, reoperation and death within 30 days postoperatively in patients of 2 groups. (2) Followup and survival situations: all the 116 patients were followed up for 5-15 months, with a median time of 8 months. Numbers of patients with tumorfree survival, tumor recurrence and tumor metastasis were 50, 6, 4 (2 with simultaneous tumor recurrence and metastasis) in the thoracoscopy and laparoscopyassisted group and 51, 5, 4 (2 with simultaneous tumor recurrence and metastasis) in the Da Vinci robotassisted group, respectively, showing no significant difference between the 2 groups (X²=0.077, 1.000, P>0.05).
Conclusions:Da Vinci robotassisted esophagectomy is safe and feasible in the treatment of esophageal cancer. Compared with combined thoracoscopy and laparoscopyassisted esophagectomy, Da Vinci robotassisted esophagectomy has comparable operation time, and is associated with a greater yield of lymph nodes along the RLN.