Short-term postoperative pain of robot-assisted <i>versus</i> thoracolaparoscopic McKeown esophagectomy for esophageal carcinoma: A non-randomized controlled trial _Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Zhihua , ZHANG Hanlu , YANG Mei , NIU Lingli , LI Jie , LIN Yidan , CHEN Longqi ,  WANG Yun

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

WANG Yun, Email: yunwwang@yeah.net

Keywords：

Esophageal neoplasms; postoperative pain; video-assisted thoracoscopy; robot-assisted surgical system

DOI：

10.7507/1007-4848.201706033

Video：

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Objective To investigate the short-term postoperative pain between robot-assisted and thoracolaparoscopic McKeown esophagectomy for esophageal carcinoma. Methods We prospectively analyzed clinical data of 77 patients with esophageal carcinoma in our hospital between September 2016 and February 2017. The patients were allocated into two groups including a robot group and a thoracolaparoscopic group. The patients underwent robot assisted McKeown esophagectomy in the robot group and thoracolaparoscopic McKeown esophagectomy in the thoracolaparoscopic group. There were 38 patients with 30 males and 8 females at average age of 60.80±6.20 years in the thoracolaparoscopic group, and 39 patients with 35 males and 4 females at average age of 60.90±7.20 years in the robot group. Results There was no statistical difference between the two groups in terms of the postoperative usage of analgesic drugs. The patients in the robot group experienced less postoperative pain on postoperative day 1, 3, 5, 6 and 7 than the patients in the thoracolaparoscopic group. The mean value of visual analogue scale (VAS) on postoperative day 1, 3, 5, 6 and 7 for the robot group and the thoracolaparoscopic group was 3.20±1.10 versus 2.70±0.90 (P=0.002), 2.75±0.96 versus 2.40±0.98 (P=0.030), 2.68±1.08 versus 2.02±0.8 (P=0.005); 2.49±0.99 versus 1.81±0.88 (P=0.003), 2.27±0.83 versus 1.51±0.61 (P<0.001), respectively. Conclusion Compared with the thoracolaparoscopic group, patients receiving robot assisted McKeown esophagectomy experience less postoperative short-term pain. However, the long-term postoperative pain for these patients needs to be further studied.

Citation： XU Zhihua, ZHANG Hanlu, YANG Mei, NIU Lingli, LI Jie, LIN Yidan, CHEN Longqi, WANG Yun. Short-term postoperative pain of robot-assisted versus thoracolaparoscopic McKeown esophagectomy for esophageal carcinoma: A non-randomized controlled trial . Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(5): 378-381. doi: 10.7507/1007-4848.201706033 Copy

1.	Wang YC, Deng HY, Wang WP, et al. Positive esophageal proximal resection margin: an important prognostic factor for esophageal cancer that warrants adjuvant therapy. J Thorac Dis, 2016, 8(9): 2512-2518.
2.	van der Sluis PC, Ruurda JP, Verhage RJ, et al. Oncologic long-term results of robot-assisted minimally invasive thoraco-laparoscopic esophagectomy with two-field lymphadenectomy for esophageal cancer. Ann Surg Oncol, 2015, 22 Suppl 3: S1350-S1356.
3.	Park SY, Kim DJ, Yu WS, et al. Robot-assisted thoracoscopic esophagectomy with extensive mediastinal lymphadenectomy: experience with 114 consecutive patients with intrathoracic esophageal cancer. Dis Esophagus, 2016, 29(4): 326-332.
4.	易俊, 熊磊, 李德闽, 等. 达芬奇机器人在食管癌外科治疗中的应用. 中国胸心血管外科临床杂志, 2015, 22(10): 910-913.
5.	韩丁培, 项捷, 高涛涛, 等. 机器人辅助与传统 Ivor-Lewis 食管癌根治术近期疗效的比较. 中国微创外科杂志, 2016, 16(5): 404-407.
6.	Menon M, Tewari A, Baize B, et al. Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology, 2002, 60(5): 864-868.
7.	范虹, 蒋伟, 袁云锋, 等. 达芬奇机器人辅助食管癌根治术 2 例报告. 复旦学报(医学版), 2010, 37(4): 502-503.
8.	Zhu ZJ, Zhao YF, Chen LQ, et al. Clinical application of layered anastomosis during esophagogastrostomy. World J Surg, 2008, 32(4): 583-588.
9.	Wildgaard K, Ravn J, Nikolajsen L, et al. Consequences of persistent pain after lung cancer surgery: a nationwide questionnaire study. Acta Anaesthesiol Scand, 2011, 55(1): 60-68.
10.	Leandro JD, Rodrigues OR, Slaets AF, et al. Comparison between two thoracotomy closure techniques: postoperative pain and pulmonary function. J Bras Pneumol, 2014, 40(4): 389-396.
11.	Maguire MF, Latter JA, Mahajan R, et al. A study exploring the role of intercostal nerve damage in chronic pain after thoracic surgery. Eur J Cardiothorac Surg, 2006, 29(6): 873-879.
12.	Suda K, Ishida Y, Kawamura Y, et al. Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes. World J Surg, 2012, 36(7): 1608-1616.
13.	Erus S, Tanju S, Kapdagli M, et al. The comparison of complication, pain, quality of life and performance after lung resections with thoracoscopy and axillary thoracotomy. Eur J Cardiothorac Surg, 2014, 46(4): 614-619.
14.	Freynhagen R, Baron R, Gockel U, et al. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin, 2006, 22(10): 1911-1920.
15.	Garcia-tirado J, Rieger-reyes C. Suture techniques of the intercostal space in thoracotomy and their relationship with post-thoracotomy pain: a systematic review. Arch Bronconeumol, 2012, 48(1): 22-28.

1. Wang YC, Deng HY, Wang WP, et al. Positive esophageal proximal resection margin: an important prognostic factor for esophageal cancer that warrants adjuvant therapy. J Thorac Dis, 2016, 8(9): 2512-2518.
2. van der Sluis PC, Ruurda JP, Verhage RJ, et al. Oncologic long-term results of robot-assisted minimally invasive thoraco-laparoscopic esophagectomy with two-field lymphadenectomy for esophageal cancer. Ann Surg Oncol, 2015, 22 Suppl 3: S1350-S1356.
3. Park SY, Kim DJ, Yu WS, et al. Robot-assisted thoracoscopic esophagectomy with extensive mediastinal lymphadenectomy: experience with 114 consecutive patients with intrathoracic esophageal cancer. Dis Esophagus, 2016, 29(4): 326-332.
4. 易俊, 熊磊, 李德闽, 等. 达芬奇机器人在食管癌外科治疗中的应用. 中国胸心血管外科临床杂志, 2015, 22(10): 910-913.
5. 韩丁培, 项捷, 高涛涛, 等. 机器人辅助与传统 Ivor-Lewis 食管癌根治术近期疗效的比较. 中国微创外科杂志, 2016, 16(5): 404-407.
6. Menon M, Tewari A, Baize B, et al. Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology, 2002, 60(5): 864-868.
7. 范虹, 蒋伟, 袁云锋, 等. 达芬奇机器人辅助食管癌根治术 2 例报告. 复旦学报(医学版), 2010, 37(4): 502-503.
8. Zhu ZJ, Zhao YF, Chen LQ, et al. Clinical application of layered anastomosis during esophagogastrostomy. World J Surg, 2008, 32(4): 583-588.
9. Wildgaard K, Ravn J, Nikolajsen L, et al. Consequences of persistent pain after lung cancer surgery: a nationwide questionnaire study. Acta Anaesthesiol Scand, 2011, 55(1): 60-68.
10. Leandro JD, Rodrigues OR, Slaets AF, et al. Comparison between two thoracotomy closure techniques: postoperative pain and pulmonary function. J Bras Pneumol, 2014, 40(4): 389-396.
11. Maguire MF, Latter JA, Mahajan R, et al. A study exploring the role of intercostal nerve damage in chronic pain after thoracic surgery. Eur J Cardiothorac Surg, 2006, 29(6): 873-879.
12. Suda K, Ishida Y, Kawamura Y, et al. Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes. World J Surg, 2012, 36(7): 1608-1616.
13. Erus S, Tanju S, Kapdagli M, et al. The comparison of complication, pain, quality of life and performance after lung resections with thoracoscopy and axillary thoracotomy. Eur J Cardiothorac Surg, 2014, 46(4): 614-619.
14. Freynhagen R, Baron R, Gockel U, et al. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin, 2006, 22(10): 1911-1920.
15. Garcia-tirado J, Rieger-reyes C. Suture techniques of the intercostal space in thoracotomy and their relationship with post-thoracotomy pain: a systematic review. Arch Bronconeumol, 2012, 48(1): 22-28.

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Short-term postoperative pain of robot-assisted versus thoracolaparoscopic McKeown esophagectomy for esophageal carcinoma: A non-randomized controlled trial

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