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

Video：

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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.	中國醫師協會胸外科分會快速康復專家委員會. 食管癌加速康復外科技術應用專家共識(2016版). 中華胸心血管外科雜志, 2016, 32(12): 717-722.
12.	王述民. 達芬奇機器人在肺癌根治術中的應用現狀及展望. 中國腫瘤, 2014, 23(9): 736-742.
13.	支修益, 劉倫旭. 中國胸外科圍手術期氣道管理指南(2020版). 中國胸心血管外科臨床雜志, 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.	中華醫學會胸心血管外科學分會胸腔鏡外科學組, 中國醫師協會胸外科醫師分會微創外科專家委員會. 中國胸外科圍手術期疼痛管理專家共識(2018版). 中國胸心血管外科臨床雜志, 2018, 25(11): 921-928.
16.	王希龍, 許世廣, 劉博, 等. 達芬奇機器人與胸腔鏡輔助小切口手術患者術后疼痛的病例對照研究. 中國胸心血管外科臨床雜志, 2016, 23(3): 230-233.
17.	王希龍, 吳子恒, 許世廣, 等. 快速康復外科理念在達芬奇機器人肺癌根治手術中應用價值研究. 臨床軍醫雜志, 2020, 48(3): 253-256.
18.	馬俊杰, 高德軍. 不同管徑胸腔引流管在肺葉切除術后的臨床應用比較. 中華胸部外科電子雜志, 2016, 3(3): 156-159.
19.	何磊. 加速康復外科在胸腹腔鏡聯合食管癌根治術中的應用. 河南外科學雜志, 2021, 27(5): 36-38.
20.	劉偉, 仲崇俊, 楊長剛. 微創外科聯合加速康復外科在食管癌圍手術期的應用. 中華胸部外科電子雜志, 2021, 8(4): 235-238.
21.	呂龍飛. 加速康復外科理念在微創Mckeown食管癌切除術中的早期臨床應用研究. 山東大學, 2020.
22.	唐勇, 區柱安, 劉巖, 等. 加速康復外科在微創食管癌根治術中的應用價值. 中華消化外科雜志, 2019, 18(6): 570-574.
23.	王春偉, 丁志丹, 王躍斌, 等. 加速康復外科在胸腹腔鏡聯合食管癌根治術中的應用. 腫瘤基礎與臨床, 2021, 34(3): 199-202.
24.	張冬蕾, 魏華兵, 周力璜, 等. 快速康復外科聯合胸腹腔鏡下食管癌根治術對老年患者的療效分析. 上海交通大學學報(醫學版), 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.	彭楓源, 林萬里, 張海, 等. 快速康復外科模式應用于食管癌患者的效果分析. 數理醫藥學雜志, 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. 中國醫師協會胸外科分會快速康復專家委員會. 食管癌加速康復外科技術應用專家共識(2016版). 中華胸心血管外科雜志, 2016, 32(12): 717-722.
12. 王述民. 達芬奇機器人在肺癌根治術中的應用現狀及展望. 中國腫瘤, 2014, 23(9): 736-742.
13. 支修益, 劉倫旭. 中國胸外科圍手術期氣道管理指南(2020版). 中國胸心血管外科臨床雜志, 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. 中華醫學會胸心血管外科學分會胸腔鏡外科學組, 中國醫師協會胸外科醫師分會微創外科專家委員會. 中國胸外科圍手術期疼痛管理專家共識(2018版). 中國胸心血管外科臨床雜志, 2018, 25(11): 921-928.
16. 王希龍, 許世廣, 劉博, 等. 達芬奇機器人與胸腔鏡輔助小切口手術患者術后疼痛的病例對照研究. 中國胸心血管外科臨床雜志, 2016, 23(3): 230-233.
17. 王希龍, 吳子恒, 許世廣, 等. 快速康復外科理念在達芬奇機器人肺癌根治手術中應用價值研究. 臨床軍醫雜志, 2020, 48(3): 253-256.
18. 馬俊杰, 高德軍. 不同管徑胸腔引流管在肺葉切除術后的臨床應用比較. 中華胸部外科電子雜志, 2016, 3(3): 156-159.
19. 何磊. 加速康復外科在胸腹腔鏡聯合食管癌根治術中的應用. 河南外科學雜志, 2021, 27(5): 36-38.
20. 劉偉, 仲崇俊, 楊長剛. 微創外科聯合加速康復外科在食管癌圍手術期的應用. 中華胸部外科電子雜志, 2021, 8(4): 235-238.
21. 呂龍飛. 加速康復外科理念在微創Mckeown食管癌切除術中的早期臨床應用研究. 山東大學, 2020.
22. 唐勇, 區柱安, 劉巖, 等. 加速康復外科在微創食管癌根治術中的應用價值. 中華消化外科雜志, 2019, 18(6): 570-574.
23. 王春偉, 丁志丹, 王躍斌, 等. 加速康復外科在胸腹腔鏡聯合食管癌根治術中的應用. 腫瘤基礎與臨床, 2021, 34(3): 199-202.
24. 張冬蕾, 魏華兵, 周力璜, 等. 快速康復外科聯合胸腹腔鏡下食管癌根治術對老年患者的療效分析. 上海交通大學學報(醫學版), 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. 彭楓源, 林萬里, 張海, 等. 快速康復外科模式應用于食管癌患者的效果分析. 數理醫藥學雜志, 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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