Robotic-assisted Ivor Lewis esophagectomy, a review of the technique

93 Background: Esophageal cancer continues to increase in incidence worldwide with the age of diagnosis continuing to move towards an older onset. Robotic assisted approaches to esophagectomy have demonstrated decreased complications and length of hospitalization (LOH). We sought to examine the impact of age on outcomes in patients undergoing robotic assisted esophagectomy (RAIL). Methods: From 2009-2013, we identified patients undergoing robotic assisted Ivor Lewis esophagectomy. Patients were then stratified according to 3 age groups. Cohort 1, age less then 50, cohort 2, age 50-70, and cohort 3 >70. Statistical comparisons between LOH, operative time (OT), estimated blood loss (EBL), adverse events (AE) and mortality were made with Kruskal-Wallis and Chi-square tests. Results: We identified 134 patients who underwent RAIL and found no statistically significant difference between the three cohorts for OT, LOH, days spent in intensive care, AE or mortality. There was a difference in EBL with higher median blood loss (150 cc) seen in cohort 1 (50-600cc) and 3 (50-400cc) compared to cohort 2 (100 cc, (25-400cc)), p < 0.01. The most common AE were arrhythmia and pneumonia but this was not significantly different between the cohorts. The overall AE rate was 10% (cohort 1), 21% (cohort 2), 34% (cohort 3), p=0.14. There were 4 leaks (p =0.38) and 2 deaths (p=0.90) in the entire cohort. A separate analysis was done to compare elderly (>70) to the non-elderly (<70). Median EBL was higher in the elderly cohort (100cc (25-600) vs 150cc (50-400), p <0.01). There was a trend towards longer LOH in the elderly (9 (4-35) vs 11 (6-38) days, p =0.06). AE and mortality were not significantly different, although there was a trend toward increased AE (19.8% vs 34%, p=0.07) in the elderly, with arrhythmia being the most common AE. Conclusions: RAIL is a safe surgical technique for use in an aging patient population. We demonstrated there was no increased risk of LOH, AE or death in the elderly patients compared to their younger cohort.

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Readmission after robotic Ivor Lewis esophagectomy: Earlier discharge, increased readmissions?

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.149 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 149-149

Author(s):

Ahmed I. Salem ◽

Ravi Shridhar ◽

Sarah E. Hoffe ◽

Khaldoun Almhanna ◽

Kenneth Meredith

Keyword(s):

Length Of Stay ◽

Neoadjuvant Therapy ◽

Statistical Tests ◽

P Value ◽

Readmission Rates ◽

Historical Cohort ◽

Ivor Lewis ◽

Robotic Assisted ◽

Ivor Lewis Esophagectomy ◽

The Impact

149 Background: Readmissions after esophagectomy are costly and incidence can be as high as 25%. The robotic assisted approach has potential benefits of earlier discharge compared to conventional techniques, however it is unclear what impact an earlier discharge will have on readmission rates. We sought to examine the impact of early discharge on readmission rates with robotic approaches. Methods: A retrospective review of all patients undergoing robotic assisted Ivor Lewis esophagectomy (RAIL) from 2009-2015 was conducted. Clinicopathologic factors and surgical outcomes were recorded and compared. We then compared outcomes to a historical cohort from the Surveillance, Epidemiology, and End Results-Medicare data (2002 to 2009). Length of stay, 30-day and 90-day readmissions, and mortality were determined. All statistical tests were two-sided and a p-value < 0.05 was considered statistically significant. Results: We identified 147 patients who underwent RAIL. There were 78.9% (116) male with an average age 66 ±10 years. Adenocarcinoma was the predominant histology in 86% (126) patients, 9.52% (14) patients had squamous cell histology, and 4.76% (7) patients had other histology. Neoadjuvant therapy was administered to 77.6% (114) patients. In the SEER database 1,744 patients with esophageal cancer underwent esophagectomy: 80% of patients (1,390) were male, with a mean age of 73 years; 71.8% of tumors (1,251) were adenocarcinomas, and 38% of patients (667) received neoadjuvant therapy. Median length of stay was 13 days, 30-day mortality was 8.8% (158 patients), and 90 day mortality was 17.9% (302) compared to median LOH of 9 days, 30-day mortality of 0.6% (1) and 90-day mortality of 1.4% (2)% in the robotic cohort, p < 0.0001, p = 0.007, and p < 0.0001. Readmission rates at 30 and 90 days were 18.6% (212) and 31.3% (356) in the SEER patients, and 3.4% (5) and 5.4% (8) in the robotic cohort p = 0.001 and p < 0.001. Conclusions: RAIL is a safe surgical technique that provides an alternative to conventional approaches to esophageal resection. Patients undergoing RAIL had lower mortality rates and LOH. Despite the lower LOH, RAIL was associated with lower 30 and 90-day readmissions.

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Su1813 Atrial Fibrillation Is a Rare Complication After Robotic Assisted Ivor Lewis Esophagectomy

Gastroenterology ◽

10.1016/s0016-5085(14)63800-2 ◽

2014 ◽

Vol 146 (5) ◽

pp. S-1042-S-1043

Author(s):

Andrea M. Abbott ◽

Ravi Shridhar ◽

Sarah Hoffe ◽

Khaldoun Almhanna ◽

Kenneth Meredith

Keyword(s):

Atrial Fibrillation ◽

Rare Complication ◽

Ivor Lewis ◽

Robotic Assisted ◽

Ivor Lewis Esophagectomy

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Robotic-assisted Ivor Lewis esophagectomy with combined stapled/sewn anastomosis

Journal of Visualized Surgery ◽

10.21037/jovs.2020.02.08 ◽

2020 ◽

Vol 6 ◽

pp. 46-46

Author(s):

Deven C. Patel ◽

Evangeline Rodriguez ◽

Fernando Espinoza-Mercardo ◽

Taryne A. Imai ◽

Harmik J. Soukiasian

Keyword(s):

Ivor Lewis ◽

Robotic Assisted ◽

Ivor Lewis Esophagectomy

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Mapping the lymphatic drainage pattern of esophageal cancer with near-infrared fluorescent imaging during robotic assisted ivor lewis esophagectomy - The ESOMAP trial

10.1055/s-0041-1733488 ◽

2021 ◽

Author(s):

D Müller ◽

L Schiffmann ◽

B Babic ◽

F Gebauer ◽

H Schlößer ◽

...

Keyword(s):

Esophageal Cancer ◽

Near Infrared ◽

Lymphatic Drainage ◽

Fluorescent Imaging ◽

Drainage Pattern ◽

Ivor Lewis ◽

Robotic Assisted ◽

Ivor Lewis Esophagectomy ◽

Lymphatic Drainage Pattern

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Concurrent Robotic-Assisted Pulmonary Lobectomy and Robotic-Assisted Ivor-Lewis Esophagectomy for Synchronous Primary Lung and Esophageal Cancers: A Case Report

CHEST Journal ◽

10.1378/chest.1836732 ◽

2014 ◽

Vol 145 (3) ◽

pp. 38A

Author(s):

Eric Toloza ◽

Lindsey Bendure ◽

Christian Sobky ◽

Joseph Garrett ◽

Nasreen Vohra ◽

...

Keyword(s):

Case Report ◽

Pulmonary Lobectomy ◽

Ivor Lewis ◽

Robotic Assisted ◽

Esophageal Cancers ◽

Ivor Lewis Esophagectomy

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How I do it: robotic-assisted Ivor Lewis esophagectomy

Diseases of the Esophagus ◽

10.1093/dote/doaa070 ◽

2020 ◽

Vol 33 (Supplement_2) ◽

Author(s):

Christopher A Heid ◽

Victor Lopez ◽

Kemp Kernstine

Keyword(s):

Minimally Invasive ◽

Minimally Invasive Techniques ◽

Ivor Lewis ◽

Robotic Assisted ◽

Surgical Technology ◽

Ivor Lewis Esophagectomy ◽

Improved Outcomes ◽

Invasive Techniques

SUMMARY Advances in minimally invasive techniques, including robotic surgical technology, have led to improved outcomes in esophagectomy. In this article, we detail our approach to the robotic Ivor Lewis esophagectomy.

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