Comparison of short-term clinical outcomes between robot- assisted minimally invasive esophagectomy and video-assisted minimally invasive esophagectomy: a systematic review and meta-analysis

Abstract

Background: Though robot-assisted minimally invasive esophagectomy (RAMIE) is demonstrated to offer a better visualization and provide a fine dissection of the mediastinal structures to facilitate the complex thoracoscopic operation, the superiorities of RAMIE over MIE have not been well verified. The aim of this study was to explore the actual superiorities through comparing short-term results of RAMIE with that of MIE. Methods: PubMed, EMBASE and web of science databases were systematically searched up to September 1, 2020 for case-controlled studies that compared RAMIE with TLMIE. Results: Fourteen studies were identified, with a total of 2,887 patients diagnosed with esophageal cancer, including 1,435 patients subjected to RAMIE group and 1,452 patients subjected to MIE group. The operative time in RAMIE was still significantly longer than that in MIE group (OR =0.785; 95% CI, 0.618-0.952; P<0.001). The incidence of pneumonia was significantly lower in RAMIE group compared with MIE group (OR =0.677; 95% CI, 0.468-0.979; P=0.038).Conclusions: RAMIE has the superiorities over MIE in short-term outcomes in terms of pneumonia and vocal cord palsy. Therefore, RAMIE could be considered as a standard treatment for patients with esophageal cancer.

Robotic Esophagectomy. A Systematic Review with Meta-Analysis of Clinical Outcomes

“…Robotic approach seemed to be superior to conventional laparoscopy in terms of oncologic outcomes (mean number of harvested nodes obtained, p = 0.001) and postoperative complications (incidence of pneumonia after surgery, p = 0.003). Even in this case robotic surgery has the only disadvantage of operative time (shorter in the laparoscopic group, p = 0.003), but this data was not associated with increased postoperative morbidities.Our results are in accordance with the results of the meta-analysis by Zheng et al [ 71 ] in terms of longer operative time in the robotic group. Similarly pneumonia rate was lower in the robotic group, and this data has been confirmed by our analysis.…”

“…More recently, Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) was introduced as an alternative minimally invasive method which may allow improved view of thoracic structures and increased precision [ 69 ]. Nevertheless, the presumed advantages of the robotic surgery are still under debate [ 69 , 70 , 71 ]. In this setting, three meta-analysis tried to assess if the robotic approach could be considered the best treatment to the esophageal cancer [ 70 , 71 , 72 ].…”

“…Nevertheless, the presumed advantages of the robotic surgery are still under debate [ 69 , 70 , 71 ]. In this setting, three meta-analysis tried to assess if the robotic approach could be considered the best treatment to the esophageal cancer [ 70 , 71 , 72 ]. In a network meta-analysis on 98 studies and 32,315 patients, Siaw-Acheampong et al [ 70 ] compared all combinations of open, laparoscopic and robotic approaches to transthoracic esophagectomy.…”

“…Their results demonstrated that compared with open surgery, both laparoscopic and robotic approaches were associated with less blood loss, significantly lower rates of pulmonary complications, shorter hospital stay and higher mean of harvested nodes, concluding that minimally invasive approaches were related with better postoperative outcomes with no compromise in oncologic results. Regarding the comparison between laparoscopic and robot-assisted approach, Zheng et al [ 71 ] identified fourteen studies with a total of 2887 patients included in the final an analysis. The Authors demonstrated that RAMIE was associated with a lower incidence of pneumonia and vocal cord palsy than MIE, but still be associated with longer operative time.…”

Totally Robotic Esophagectomy

“…Since then, several other studies have also confirmed the same results, reporting that robotic surgery showed better performance in dissection along the RLN nodes than thoracoscopic surgery [ 12 , 18 , 30 , 31 ]. Other researchers reported a reduced incidence of RLN palsy after robotic surgery, which may be another advantage of robotic esophagectomy [ 32 - 34 ]. Zheng et al [ 34 ] also documented a lower incidence of vocal cord palsy in the robotic surgery group in their meta-analysis.…”