ASO Author Reflections: Modern-Day Implementation of Robotic Esophagogastric Cancer Surgery

Abstract Background Robotic esophagogastric cancer surgery is gaining widespread adoption. This population-based cohort study aimed to compare rates of textbook outcomes (TOs) and survival from robotic minimally invasive techniques for esophagogastric cancer. Methods Data from the United States National Cancer Database (NCDB) (2010–2017) were used to identify patients with non-metastatic esophageal or gastric cancer receiving open surgery (to the esophagus, n = 11,442; stomach, n = 22,183), laparoscopic surgery (to the esophagus [LAMIE], n = 4827; stomach [LAMIG], n = 6359), or robotic surgery (to the esophagus [RAMIE], n = 1657; stomach [RAMIG], n = 1718). The study defined TOs as 15 or more lymph nodes examined, margin-negative resections, hospital stay less than 21 days, no 30-day readmissions, and no 90-day mortalities. Multivariable logistic regression and Cox analyses were used to account for treatment selection bias. Results Patients receiving robotic surgery were more commonly treated in high-volume academic centers with advanced clinical T and N stage disease. From 2010 to 2017, TO rates increased for esophageal and gastric cancer treated via all surgical techniques. Compared with open surgery, significantly higher TO rates were associated with RAMIE (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.27–1.58) and RAMIG (OR 1.30; 95% CI 1.17–1.45). For esophagectomy, long-term survival was associated with both TO (hazard ratio [HR 0.64, 95% CI 0.60–0.67) and RAMIE (HR 0.92; 95% CI 0.84–1.00). For gastrectomy, long-term survival was associated with TO (HR 0.58; 95% CI 0.56–0.60) and both LAMIG (HR 0.89; 95% CI 0.85–0.94) and RAMIG (HR 0.88; 95% CI 0.81–0.96). Subset analysis in high-volume centers confirmed similar findings. Conclusion Despite potentially adverse learning curve effects and more advanced tumor stages captured during the study period, both RAMIE and RAMIG performed in mostly high-volume centers were associated with improved TO and long-term survival. Therefore, consideration for wider adoption but a well-designed phase 3 randomized controlled trial (RCT) is required for a full evaluation of the benefits conferred by robotic techniques for esophageal and gastric cancers.

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Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery

JAMA Surgery ◽

10.1001/jamasurg.2018.1645 ◽

2018 ◽

Vol 153 (12) ◽

pp. 1081 ◽

Cited By ~ 62

Author(s):

Enrico M. Minnella ◽

Rashami Awasthi ◽

Sarah-Eve Loiselle ◽

Ramanakumar V. Agnihotram ◽

Lorenzo E. Ferri ◽

...

Keyword(s):

Functional Capacity ◽

Cancer Surgery ◽

Esophagogastric Cancer

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P-OGC87 Robotic Techniques in Esophagogastric Cancer Surgery: An Assessment of Short- and Long-term Clinical Outcomes

British Journal of Surgery ◽

10.1093/bjs/znab430.214 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Sivesh Kamarajah ◽

Ewen Griffiths ◽

Alexander Phillips ◽

Jelle Ruurda ◽

Richard van Hillegersberg ◽

...

Keyword(s):

High Volume ◽

The United States ◽

Cancer Surgery ◽

Phase Iii ◽

Term Survival ◽

Long Term Survival ◽

Gastric Cancers ◽

Tumor Stages ◽

Esophagogastric Cancer

Abstract Background Robotic esophagogastric cancer surgery is gaining widespread adoption. This population-based cohort study aimed to compare rates of textbook outcomes (TO) and survival from robotic minimally invasive techniques for esophagogastric cancers. Methods Data from the United States National Cancer Database (NCDB) (2010-2017), was used to identify patients with non-metastatic esophageal and gastric cancers receiving open (esophagus, n = 11,442; stomach, n = 22,183), laparoscopic (esophagus (LAMIE), n = 4,827; stomach (LAMIG), n = 6,359) or robotic (esophagus (RAMIE), n = 1,657; stomach (RAMIG), n = 1,718) surgery. TO were defined as lymph nodes examined >15, margin-negative resections, length of stay <21 days, no 30-day readmission, and no 90-day mortality. Multivariable logistic regression and Cox analyses were used to account for treatment selection bias. Results Patients receiving robotic surgery were more commonly treated within high volume, academic centers and with advanced clinical T and N stage disease. From 2010 to 2017, TO rates increased for esophageal and gastric cancer treated by all surgical techniques. RAMIE (odds ratio (OR):1.41, (CI 95% : 1.27-1.58) and RAMIG (OR:1.30, CI 95% : 1.17-1.45) had significantly higher TO rates compared to open surgery. For esophagectomy, TO (hazard ratio (HR):0.64, CI 95% : 0.60-0.67) and RAMIE (HR:0.92, CI 95% : 0.84-1.00) were both associated with long-term survival. For gastrectomy, TO (HR:0.58, CI 95% : 0.56-0.60) and both LAMIG (HR:0.89, CI 95% : 0.85-0.94) and RAMIG (HR:0.88, CI 95% : 0.81-0.96) were all associated with long-term survival. Subset analysis in high volume centers confirmed similar findings. Conclusions Despite potentially adverse learning curve effects and more advanced tumor stages captured within the study period, both RAMIE and RAMIG, as performed in mostly high-volume centers, were associated with improved TO and long-term survival. Therefore, consideration for wider adoption but a well-designed phase III RCT is required to fully evaluate the benefits of robotic techniques in esophageal and gastric cancers.

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Considerations in Prehabilitation for Esophagogastric Cancer Surgery

JAMA Surgery ◽

10.1001/jamasurg.2018.5575 ◽

2019 ◽

Vol 154 (5) ◽

pp. 463

Author(s):

Ian Jun Yan Wee

Keyword(s):

Cancer Surgery ◽

Esophagogastric Cancer

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Cancer Cachexia: The Comparative Mechanisms of Weight Loss after Esophagectomy and Bariatric Surgery

OBM Integrative and Complementary Medicine ◽

10.21926/obm.icm.2102017 ◽

2020 ◽

Vol 06 (02) ◽

pp. 1-1

Author(s):

David J Tansey ◽

◽

Carel W le Roux ◽

◽

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Oesophageal Cancer ◽

Survival Rates ◽

Cancer Surgery ◽

Unintentional Weight Loss ◽

Curative Intent ◽

Gut Hormone ◽

Esophagogastric Cancer ◽

Hormone Signalling

Oesophageal cancer is the ninth most common cancer and the sixth most common cause of cancer deaths worldwide [1]. Over the past number of years, due to earlier diagnosis and better treatment, we are seeing improvements in the survival rates of oesophageal cancer, with more patients living longer post-esophagectomy surgery. Unintentional weight loss is a common unintended feature seen in patients post-esophagectomy done with curative intent. Many recent studies have demonstrated the links between the pathophysiology of the weight loss following esophagogastric cancer surgery and the biological mechanism of weight loss following bariatric surgery. The predominant cause of the weight loss in both circumstances appears to the postoperative alterations in gut hormone signalling. This paper explores these over-lapping gut hormones signalling mechanisms and discusses the use of this increased understanding of hormone signalling to develop potential pharmacologic targets for the management of unintentional weight loss post-esophagogastric cancer surgery.

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