Short-term outcomes of robot-assisted minimally invasive esophagectomy for esophageal cancer: a propensity score matched analysis

Abstract Aim The aim of this study was to describe postoperative complications and short-term oncologic outcomes for RAMIE4 with intrathoracic anastomosis for esophageal cancer within our case series of 100 consecutive patients. Background & Methods Robot assisted minimally-invasive esophagectomy (RAMIE) with intrathoracic anastomosis is gaining popularity as a treatment for esophageal cancer. In this study, we present the results of 100 RAMIE procedures using the da Vinci Xi robotic system (RAMIE4). The aim of this study was to describe postoperative complications and short-term oncologic outcomes for RAMIE4 within our case series of 100 consecutive patients. Between January 2017 and February 2019, data of 100 consecutive patients with esophageal carcinoma undergoing modified Ivor-Lewis esophagectomy were prospectively collected. All operations were performed by the same surgeon using an identical intrathoracic anastomotic reconstruction technique with the same perioperative management and pain control regimen. Intra-operatively and post operatively complications were graded according to definitions stated by the Esophagectomy Complications Consensus Group (ECCG). Results Mean duration of the surgical procedure was 416 min (± 80). In total, 70 patients (70%) had an uncomplicated operative procedure and postoperative recovery. Pulmonary complications were most common and were observed in 17 patients (17 %). Anastomotic leakage was observed in 8 patients (8%). Median ICU stay was 1 day and median overall postoperative hospital stay was 11 days. 30 day mortality was 1%. A R0 resection was reached in 92% of patients with a median number of 29 dissected lymph nodes. Conclusion RAMIE4 with intrathoracic anastomosis for esophageal cancer or cancer located in the esophagus was technically feasible and safe. Postoperative complications and short term oncologic results were comparable to the highest international standards nowadays. These results could only be obtained due to a structured RAMIE training pathway. The superiority of RAMIE compared to conventional minimally invasive esophagus is currently investigated in multiple randomized controlled trials. Results of these trials will define the role for RAMIE for patients with esophageal cancer in the future.

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Comparison of short-term outcomes between robot-assisted minimally invasive esophagectomy and video-assisted minimally invasive esophagectomy in treating middle thoracic esophageal cancer

Diseases of the Esophagus ◽

10.1093/dote/doy012 ◽

2018 ◽

Vol 31 (8) ◽

Cited By ~ 18

Author(s):

H-Y Deng ◽

W-X Huang ◽

G Li ◽

S-X Li ◽

J Luo ◽

...

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Robot Assisted ◽

Short Term ◽

Thoracic Esophageal Cancer ◽

Invasive Esophagectomy ◽

Video Assisted

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Robot-assisted minimally invasive esophagectomy (RAMIE) compared to conventional minimally invasive esophagectomy (MIE) for esophageal cancer: a propensity-matched analysis

Diseases of the Esophagus ◽

10.1093/dote/doz060 ◽

2019 ◽

Vol 33 (4) ◽

Cited By ~ 19

Author(s):

E Tagkalos ◽

L Goense ◽

M Hoppe-Lotichius ◽

J P Ruurda ◽

B Babic ◽

...

Keyword(s):

Esophageal Cancer ◽

Postoperative Complications ◽

Propensity Score ◽

Minimally Invasive ◽

Propensity Score Matching ◽

Minimally Invasive Esophagectomy ◽

Reconstruction Technique ◽

Robot Assisted ◽

Invasive Esophagectomy ◽

Icu Stay

SUMMARY Robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly being applied as treatment for esophageal cancer. In this study, the results of 50 RAMIE procedures were compared with 50 conventional minimally invasive esophagectomy (MIE) operations, which had been the standard treatment for esophageal cancer prior to the robotic era. Between April 2016 and March 2018, data of 100 consecutive patients with esophageal carcinoma undergoing modified Ivor Lewis esophagectomy were prospectively collected. All operations were performed by the same surgeon using an identical intrathoracic anastomotic reconstruction technique with the same perioperative management and pain control regimen. Intra-operative and postoperative complications were graded according to definitions stated by the Esophagectomy Complications Consensus Group. Data analysis was carried out with and without propensity score matching. Baseline characteristics did not show significant differences between the RAMIE and MIE group. Propensity score matching of the initial group of 100 patients resulted in two equal groups of 40 patients for each surgical approach. In the RAMIE group, the median total lymph node yield was 27 (range 13–84) compared to 23 in the MIE group (range 11–48), P = 0.053. Median intensive care unit (ICU) stay was 1 day (range 1–43) in the RAMIE group compared to 2 days (range 1–17) in the MIE group (P = 0.029). The incidence of postoperative complications was not significantly different between the two groups (P = 0.581). In this propensity-matched study comparing RAMIE to MIE, ICU stay was significantly shorter in the RAMIE group. There was a trend in improved lymphadenectomy in RAMIE.

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112 ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY CAN BE PERFORMED EVEN IN LEARNING CURVE PERIOD; PROPENSITY SCORE MATCH ANALYSIS

Diseases of the Esophagus ◽

10.1093/dote/doab052.112 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Shigeru Tsunoda ◽

Kazutaka Obama ◽

Shigeo Hisamori ◽

Tatsuto Nishigori ◽

Rei Mizuno ◽

...

Keyword(s):

Propensity Score ◽

Minimally Invasive ◽

Learning Curve ◽

Propensity Score Match ◽

Minimally Invasive Esophagectomy ◽

Robot Assisted ◽

Short Term ◽

Match Analysis ◽

Invasive Esophagectomy ◽

Propensity Score Match Analysis

Abstract Da Vinci Surgical System Xi was introduced in our institution in 2017. Since then we started robot-assisted minimally invasive esophagectomy (RAMIE) as private practice. Japanese national insurance system started to reimburse RAMIE in 2018. Since then, the number of RAMIE is explosively increasing. Currently the indication of RAMIE in our institution purely depends on machine availability. However, the real clinical benefit of RAMIE over conventional minimally invasive esophagectomy (MIE) remains unknown. Methods Between January 2015 and January 2020, data of 156 consecutive patients with esophageal carcinoma undergoing esophagectomy was retrospectively reviewed. After exclusion of 12 salvage esophagectomy for patients after definitive chemoradiotherapy (>50Gy), 10 mediastinoscopic esophagectomy, 5 esophagectomy without upper mediastinal dissection, 2 two-stage esophagectomy and 1 total pharyngo-laryngo-esophagectomy, 126 patients (46 RAMIE and 80 MIE) were included in the analysis. The 1:1 propensity score match analysis was performed to compare the short-term outcomes between RAMIE and MIE. Results After matching, 45 RAMIE and 45 MIE were analyzed. RAMIE took significantly longer thoracic operation time (370 min vs. 288 min; P < 0.0001). Intraoperative blood loss (80 g vs. 50 g; P = 0.0759), harvested thoracic nodes (22 vs 25; P = 0.1188), harvested upper mediastinal nodes (12 vs 12; P = 0.4233) were similar. RAMIE showed less severe postoperative morbidity (Clavien-Dindo Grade III or higher) (9% vs. 22%; P = 0.0810) and lower incidence of recurrent laryngeal nerve palsy (Clavien-Dindo Grade II or higher) (7% vs. 18%; P = 0.1076). There was no postoperative death in both groups. Conclusion Although this result contains our early learning curve period of RAMIE, short term outcome of RAMIE is acceptable from a safety point of view.

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