亚洲食管胃癌症机器人手术的现状与未来展望
Current Status and Future Perspectives of Robotic Surgery for Esophagogastric Cancer in Asia.
作者
作者单位
- Department of Surgery University Surgical Cluster, National University Health System Singapore Singapore.
摘要
中文
机器人辅助手术（RAS）已从实验性辅助手段发展成为亚洲部分地区胃肠（GI）肿瘤实践中日益成熟的组成部分，该地区承担着不成比例的高胃癌和食管癌负担。亚洲外科医生一直是机器人胃切除术和机器人辅助微创食管切除术临床证据基础的最早和最多产的贡献者之一。这篇叙述性综述综合了随机试验（包括ROBOT、RAMIE和REVATE试验，以及正在进行的MONA LISA [JCOG1907]研究）、多中心前瞻性和倾向性匹配队列研究以及最近的荟萃分析的证据，以批判性评估RAS在亚洲的有效性、安全性、成本和未来轨迹。在多个韩国、日本和中国系列中，与传统的腹腔镜或胸腔镜方法相比，RG和RAMIE与短期发病率降低、技术要求高的解剖区域淋巴结清扫改善以及喉返神经损伤率降低相关；然而，关于长期肿瘤学结果的许多证据仍然是回顾性的或来自倾向性评分分析，而非成熟的随机数据，且研究结果并不总是一致的。我们认为，亚洲的机器人手术最好被理解为经历三个重叠的转变：技术和肿瘤学验证、经济和教育的民主化，以及数字和远程手术整合，每个转变都带有不同且未解决的问题。我们得出结论，虽然RAS已经明显改变了亚洲高容量中心的上消化道外科实践，但其作为该地区明确标准的地位应等待更长期的随机结果、标准化认证以及更公平的区域部署。
English
Robotic-assisted surgery (RAS) has moved from an experimental adjunct to an increasingly established component of gastrointestinal (GI) oncological practice in parts of Asia, a region that carries a disproportionately high burden of gastric and esophageal cancer. Asian surgeons have been among the earliest and most prolific contributors to the clinical evidence base for robotic gastrectomy and robot-assisted minimally invasive esophagectomy. This narrative review synthesizes evidence from randomized trials (including the ROBOT, RAMIE, and REVATE trials, and the ongoing MONA LISA [JCOG1907] study), multicenter prospective and propensity-matched cohort studies, and recent meta-analyses to critically appraise the efficacy, safety, cost, and future trajectory of RAS in Asia. Across multiple Korean, Japanese, and Chinese series, RG and RAMIE are associated with reduced short-term morbidity, improved lymph node retrieval in technically demanding anatomic regions, and lower rates of recurrent laryngeal nerve injury compared with conventional laparoscopic or thoracoscopic approaches; however, much of the evidence on long-term oncological outcomes remains retrospective or derived from propensity-score analyses rather than mature randomized data, and results across studies are not always concordant. We argue that robotic surgery in Asia is best understood as passing through three overlapping transitions: technical and oncological validation, economic and educational democratization, and digital and telesurgical integration, each of which carries distinct and unresolved questions. We conclude that while RAS has demonstrably reshaped upper GI surgical practice in high-volume Asian centers, its designation as a definitive regional standard of care should await longer-term randomized outcomes, standardized credentialing, and more equitable deployment across the region.
分类与指标
- 研究类型
- 综述Meta
- 病种
- 食管癌
- JCR 分区
- Q2
- 影响因子
- 3.2
- 新锐分区
- 2区