Application of enhanced recovery after surgery in da Vinci robotic McKeown surgery for esophageal cancer: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HAN Zhiwei ^1,2,3,4 , LIN Ruijiang ^1,2,3,4 , MA Minjie ^1,2,3,4 , LI Qiong ¹ , WANG Chenhan ^1,2,3,4 ,  HAN Biao ^2,3,4

1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, P. R. China;
2. Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, P. R. China;
3. Major in R & D and Application of Key Technologies in Thoracic Surgery, Gansu International Science and Technology Cooperation Base, Lanzhou, 730000, P. R. China;
4. Gansu Provincial Medical Quality Control Center of Thoracic Surgery, Lanzhou, 730000, P. R. China;

Corresponding author：

HAN Biao, Email: hanbiao66@163.com

Keywords：

Enhanced recovery after surgery; da Vinci robot; esophageal cancer; McKeown surgery; retrospective cohort study

DOI：

10.7507/1007-4848.202202022

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Objective To investigate the application of enhanced recovery after surgery (ERAS) in da Vinci robotic McKeown surgery for esophageal cancer. Methods Clinical data of patients admitted to the First Hospital of Lanzhou University and undergoing da Vinci robotic McKeown surgery for esophageal cancer from 2017 to 2021 were retrospectively analyzed. According to the treatment, they were divided into two groups, a conventional group and an ERAS group. Patients in the conventional group were treated with the conventional perioperative treatment mode of thoracic surgery, and patients in the ERAS group were treated with accelerated rehabilitation surgical treatment mode. Relevant hospitalization indicators and postoperative complication rates were compared between the two groups. Results Finally 128 patients were collected, including 106 males and 22 females, with an average age of 61.91 years. There were 71 patients in the conventional group and 57 patients in the ERAS group. The postoperative pain index in the ERAS group was significantly lower than that in the conventional group (P<0.05), and the duration of postoperative analgesic pump used in the ERAS group was shorter than that in the conventional group (2.39±0.49 d vs. 3.13±0.63 d, P<0.001). There was no statistical difference in the incidence of postoperative related complications (gastroesophageal reflux, anastomotic stenosis, anastomotic fistula, arrhythmia, recurrent laryngeal nerve injury, chylothorax, anastomosis stomatitis or incisional infection) between the two groups (P>0.05), but the incidence of postoperative lung infection in the ERAS group was statistically lower (12.28% vs. 26.76%, P=0.043), and the volume of postoperative pleural effusion was statistically less compared with the conventional group (P<0.05). In the ERAS group, the surgery time (294.35±15.19 min vs. 322.79±59.09 min, P<0.001), postoperative exhaust time (1.44±0.39 d vs. 1.94±0.43 d, P<0.001), postoperative removal time of nasolasal tube (6.79±0.73 d vs. 8.21±0.86 d, P<0.001), hospital stay (19.88±3.36 d vs. 21.34±3.59 d, P=0.020), hospitalization costs (105 575.28±8 960.75 yuan vs. 137 894.64±19 518.60 yuan, P<0.001) were all lower or shorter than those of the conventional group. Postoperative activity was longer in the ERAS group than that in the conventional group (P<0.05), but there was no statistical difference in preoperative anesthesia time between the two groups (P=0.841). Conclusion The application of ERAS in da Vinci robotic McKeown surgery for esophageal cancer can effectively alleviate the physiological and psychological burden of patients, reduce the occurrence of postoperative related complications, effectively shorten the total hospital stay, save hospitalization costs, and reduce the economic burden of patients and society. Therefore, it can be promoted and applied in the clinic.

Citation： HAN Zhiwei, LIN Ruijiang, MA Minjie, LI Qiong, WANG Chenhan, HAN Biao. Application of enhanced recovery after surgery in da Vinci robotic McKeown surgery for esophageal cancer: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1415-1421. doi: 10.7507/1007-4848.202202022 Copy

1.	Deng HY, Luo J, Li SX, et al. Does robot-assisted minimally invasive esophagectomy really have the advantage of lymphadenectomy over video-assisted minimally invasive esophagectomy in treating esophageal squamous cell carcinoma? A propensity score-matched analysis based on short-term outcomes. Dis Esophagus, 2019, 32(7): doy110.
2.	Motoyama S, Sato Y, Wakita A, et al. Lower local recurrence rate after robot-assisted thoracoscopic esophagectomy than conventional thoracoscopic surgery for esophageal cancer. Sci Rep, 2021, 11(1): 6774.
3.	Tsunoda S, Obama K. ASO author reflections: Clinical benefit of robot-assisted minimally invasive esophagectomy over conventional minimally invasive esophagectomy. Ann Surg Oncol, 2021, 28(2): 648-649.
4.	Yang Y, Zhang X, Li B, et al. Robot-assisted esophagectomy (RAE) versus conventional minimally invasive esophagectomy (MIE) for resectable esophageal squamous cell carcinoma: Protocol for a multicenter prospective randomized controlled trial (RAMIE trial, robot-assisted minimally invasive Esophagectomy). BMC Cancer, 2019, 19(1): 608.
5.	Li XK, Xu Y, Zhou H, et al. Does robot-assisted minimally invasive oesophagectomy have superiority over thoraco-laparoscopic minimally invasive oesophagectomy in lymph node dissection? Dis Esophagus, 2021, 34(2): doaa050.
6.	Tagkalos E, Goense L, Hoppe-Lotichius M, et al. Robot-assisted minimally invasive esophagectomy (RAMIE) compared to conventional minimally invasive esophagectomy (MIE) for esophageal cancer: A propensity-matched analysis. Dis Esophagus, 2020, 33(4): doz060.
7.	Tagkalos E, van der Sluis PC, Berlth F, et al. Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus minimally invasive esophagectomy for resectable esophageal adenocarcinoma, a randomized controlled trial (ROBOT-2 trial). BMC Cancer, 2021, 21(1): 1060.
8.	Xu Y, Li XK, Cong ZZ, et al. Long-term outcomes of robotic-assisted versus thoraco-laparoscopic McKeown esophagectomy for esophageal cancer: A propensity score-matched study. Dis Esophagus, 2021, 34(9): doaa114.
9.	Meredith K, Huston J, Andacoglu O, et al. Safety and feasibility of robotic-assisted Ivor-Lewis esophagectomy. Dis Esophagus, 2018, 31(7): doy005.
10.	Spadoni GF, Stratford PW, Solomon PE, et al. The evaluation of change in pain intensity: A comparison of the P4 and single-item numeric pain rating scales. J Orthop Sports Phys Ther, 2004, 34(4): 187-193.
11.	中国医师协会胸外科分会快速康复专家委员会. 食管癌加速康复外科技术应用专家共识(2016版). 中华胸心血管外科杂志, 2016, 32(12): 717-722.
12.	王述民. 达芬奇机器人在肺癌根治术中的应用现状及展望. 中国肿瘤, 2014, 23(9): 736-742.
13.	支修益, 刘伦旭. 中国胸外科围手术期气道管理指南(2020版). 中国胸心血管外科临床杂志, 2021, 28(3): 251-262.
14.	Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate therapy. Curr Opin Anaesthesiol, 2015, 28(3): 364-369.
15.	中华医学会胸心血管外科学分会胸腔镜外科学组, 中国医师协会胸外科医师分会微创外科专家委员会. 中国胸外科围手术期疼痛管理专家共识(2018版). 中国胸心血管外科临床杂志, 2018, 25(11): 921-928.
16.	王希龙, 许世广, 刘博, 等. 达芬奇机器人与胸腔镜辅助小切口手术患者术后疼痛的病例对照研究. 中国胸心血管外科临床杂志, 2016, 23(3): 230-233.
17.	王希龙, 吴子恒, 许世广, 等. 快速康复外科理念在达芬奇机器人肺癌根治手术中应用价值研究. 临床军医杂志, 2020, 48(3): 253-256.
18.	马俊杰, 高德军. 不同管径胸腔引流管在肺叶切除术后的临床应用比较. 中华胸部外科电子杂志, 2016, 3(3): 156-159.
19.	何磊. 加速康复外科在胸腹腔镜联合食管癌根治术中的应用. 河南外科学杂志, 2021, 27(5): 36-38.
20.	刘伟, 仲崇俊, 杨长刚. 微创外科联合加速康复外科在食管癌围手术期的应用. 中华胸部外科电子杂志, 2021, 8(4): 235-238.
21.	吕龙飞. 加速康复外科理念在微创Mckeown食管癌切除术中的早期临床应用研究. 山东大学, 2020.
22.	唐勇, 区柱安, 刘岩, 等. 加速康复外科在微创食管癌根治术中的应用价值. 中华消化外科杂志, 2019, 18(6): 570-574.
23.	王春伟, 丁志丹, 王跃斌, 等. 加速康复外科在胸腹腔镜联合食管癌根治术中的应用. 肿瘤基础与临床, 2021, 34(3): 199-202.
24.	张冬蕾, 魏华兵, 周力璜, 等. 快速康复外科联合胸腹腔镜下食管癌根治术对老年患者的疗效分析. 上海交通大学学报(医学版), 2021, 41(1): 74-77.
25.	Liu CY, Hsu PK, Leong KI, et al. Is tubeless uniportal video-assisted thoracic surgery for pulmonary wedge resection a safe procedure? Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i70-i76.
26.	彭枫源, 林万里, 张海, 等. 快速康复外科模式应用于食管癌患者的效果分析. 数理医药学杂志, 2020, 33(7): 1073-1075.

1. Deng HY, Luo J, Li SX, et al. Does robot-assisted minimally invasive esophagectomy really have the advantage of lymphadenectomy over video-assisted minimally invasive esophagectomy in treating esophageal squamous cell carcinoma? A propensity score-matched analysis based on short-term outcomes. Dis Esophagus, 2019, 32(7): doy110.
2. Motoyama S, Sato Y, Wakita A, et al. Lower local recurrence rate after robot-assisted thoracoscopic esophagectomy than conventional thoracoscopic surgery for esophageal cancer. Sci Rep, 2021, 11(1): 6774.
3. Tsunoda S, Obama K. ASO author reflections: Clinical benefit of robot-assisted minimally invasive esophagectomy over conventional minimally invasive esophagectomy. Ann Surg Oncol, 2021, 28(2): 648-649.
4. Yang Y, Zhang X, Li B, et al. Robot-assisted esophagectomy (RAE) versus conventional minimally invasive esophagectomy (MIE) for resectable esophageal squamous cell carcinoma: Protocol for a multicenter prospective randomized controlled trial (RAMIE trial, robot-assisted minimally invasive Esophagectomy). BMC Cancer, 2019, 19(1): 608.
5. Li XK, Xu Y, Zhou H, et al. Does robot-assisted minimally invasive oesophagectomy have superiority over thoraco-laparoscopic minimally invasive oesophagectomy in lymph node dissection? Dis Esophagus, 2021, 34(2): doaa050.
6. Tagkalos E, Goense L, Hoppe-Lotichius M, et al. Robot-assisted minimally invasive esophagectomy (RAMIE) compared to conventional minimally invasive esophagectomy (MIE) for esophageal cancer: A propensity-matched analysis. Dis Esophagus, 2020, 33(4): doz060.
7. Tagkalos E, van der Sluis PC, Berlth F, et al. Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus minimally invasive esophagectomy for resectable esophageal adenocarcinoma, a randomized controlled trial (ROBOT-2 trial). BMC Cancer, 2021, 21(1): 1060.
8. Xu Y, Li XK, Cong ZZ, et al. Long-term outcomes of robotic-assisted versus thoraco-laparoscopic McKeown esophagectomy for esophageal cancer: A propensity score-matched study. Dis Esophagus, 2021, 34(9): doaa114.
9. Meredith K, Huston J, Andacoglu O, et al. Safety and feasibility of robotic-assisted Ivor-Lewis esophagectomy. Dis Esophagus, 2018, 31(7): doy005.
10. Spadoni GF, Stratford PW, Solomon PE, et al. The evaluation of change in pain intensity: A comparison of the P4 and single-item numeric pain rating scales. J Orthop Sports Phys Ther, 2004, 34(4): 187-193.
11. 中国医师协会胸外科分会快速康复专家委员会. 食管癌加速康复外科技术应用专家共识(2016版). 中华胸心血管外科杂志, 2016, 32(12): 717-722.
12. 王述民. 达芬奇机器人在肺癌根治术中的应用现状及展望. 中国肿瘤, 2014, 23(9): 736-742.
13. 支修益, 刘伦旭. 中国胸外科围手术期气道管理指南(2020版). 中国胸心血管外科临床杂志, 2021, 28(3): 251-262.
14. Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate therapy. Curr Opin Anaesthesiol, 2015, 28(3): 364-369.
15. 中华医学会胸心血管外科学分会胸腔镜外科学组, 中国医师协会胸外科医师分会微创外科专家委员会. 中国胸外科围手术期疼痛管理专家共识(2018版). 中国胸心血管外科临床杂志, 2018, 25(11): 921-928.
16. 王希龙, 许世广, 刘博, 等. 达芬奇机器人与胸腔镜辅助小切口手术患者术后疼痛的病例对照研究. 中国胸心血管外科临床杂志, 2016, 23(3): 230-233.
17. 王希龙, 吴子恒, 许世广, 等. 快速康复外科理念在达芬奇机器人肺癌根治手术中应用价值研究. 临床军医杂志, 2020, 48(3): 253-256.
18. 马俊杰, 高德军. 不同管径胸腔引流管在肺叶切除术后的临床应用比较. 中华胸部外科电子杂志, 2016, 3(3): 156-159.
19. 何磊. 加速康复外科在胸腹腔镜联合食管癌根治术中的应用. 河南外科学杂志, 2021, 27(5): 36-38.
20. 刘伟, 仲崇俊, 杨长刚. 微创外科联合加速康复外科在食管癌围手术期的应用. 中华胸部外科电子杂志, 2021, 8(4): 235-238.
21. 吕龙飞. 加速康复外科理念在微创Mckeown食管癌切除术中的早期临床应用研究. 山东大学, 2020.
22. 唐勇, 区柱安, 刘岩, 等. 加速康复外科在微创食管癌根治术中的应用价值. 中华消化外科杂志, 2019, 18(6): 570-574.
23. 王春伟, 丁志丹, 王跃斌, 等. 加速康复外科在胸腹腔镜联合食管癌根治术中的应用. 肿瘤基础与临床, 2021, 34(3): 199-202.
24. 张冬蕾, 魏华兵, 周力璜, 等. 快速康复外科联合胸腹腔镜下食管癌根治术对老年患者的疗效分析. 上海交通大学学报(医学版), 2021, 41(1): 74-77.
25. Liu CY, Hsu PK, Leong KI, et al. Is tubeless uniportal video-assisted thoracic surgery for pulmonary wedge resection a safe procedure? Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i70-i76.
26. 彭枫源, 林万里, 张海, 等. 快速康复外科模式应用于食管癌患者的效果分析. 数理医药学杂志, 2020, 33(7): 1073-1075.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of enhanced recovery after surgery in da Vinci robotic McKeown surgery for esophageal cancer: A retrospective cohort study

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