Despite advancements in multidisciplinary treatment, esophagectomy remains the primary curative treatment for esophageal cancer. Given that lymph node metastases can spread from the cervical to abdominal regions, three-field lymph node dissection has been established as a standard approach. However, this highly invasive procedure involves multiple anatomical regions—thoracic, abdominal, and cervical—leading to significant surgical burden. To reduce surgical invasiveness, minimally invasive esophagectomy (MIE) has become increasingly common worldwide. With its adoption and advancements in multidisciplinary therapy, discussions have emerged regarding the potential omission of lymph node dissection in selected cases. Since the introduction of robot-assisted minimally invasive esophagectomy (RAMIE) in 2004, this technique has progressively replaced conventional MIE. Robotic systems—equipped with a magnified 3D camera, articulated instruments, and tremor filtering—allow surgeons to perform complex procedures with greater precision than manual techniques. One randomized controlled trial (RCT) has demonstrated fewer postoperative complications with RAMIE compared to open esophagectomy. Additionally, RAMIE has been shown to enable more extensive lymph node dissection around the left recurrent laryngeal nerve than conventional MIE. However, the long-term oncological benefits of RAMIE remain unproven, as no RCTs have definitely confirmed its impact on long-term survival in esophageal cancer patients. Ongoing randomized trials are expected to provide further insights into its prognostic benefits.
尽管多学科治疗取得了进展，食管切除术仍是食管癌的主要根治性治疗手段。鉴于淋巴结转移可从颈部扩散至腹部区域，三野淋巴结清扫术已被确立为标准术式。然而，这种高侵袭性手术涉及胸、腹、颈多个解剖区域，导致显著的手术负担。为降低手术创伤，微创食管切除术在全球范围内日益普及。随着该技术的应用及多学科治疗的进步，学界开始探讨在特定病例中是否可能省略淋巴结清扫。自2004年机器人辅助微创食管切除术问世以来，该技术逐步取代传统微创食管切除术。机器人系统配备放大三维摄像头、关节式器械及震颤过滤功能，使外科医生能够以比人工操作更高的精度完成复杂手术。一项随机对照试验表明，与开放食管切除术相比，机器人辅助微创食管切除术术后并发症更少。此外，研究显示该技术相比传统微创食管切除术，能更彻底地清扫左侧喉返神经周围淋巴结。然而，机器人辅助微创食管切除术的长期肿瘤学获益尚未得到证实，目前尚无随机对照试验明确其对食管癌患者长期生存的影响。正在进行的随机试验有望为其预后获益提供进一步依据。
Development in Esophagectomy for Esophageal Cancer: The Current Standing Point of Robotic Surgery
肿瘤(癌症)患者之家