Comparison of the short-term outcomes of robot-assisted minimally invasive, video-assisted minimally invasive, and open esophagectomy

Abstract

Background: The development of minimally invasive surgery has initiated many changes in the surgical treatment of esophageal cancer (EC) patients. The aim of this study was to compare the short-term outcomes of robotic-assisted minimally invasive esophagectomy (RAMIE), video-assisted minimally invasive esophagectomy (VAMIE), and open esophagectomy (OE). Methods: Our study included patients who had undergone McKeown esophagectomy at Tianjin Medical University Cancer Institute and Hospital between January 2016 and December 2018. We analyzed clinical baseline data, as well as perioperative and pathological outcomes. Results: A total of 312 cases met the inclusion criteria (OE: 77, VAMIE: 144, RAMIE: 91). The OE group had a greater number of late-stage patients as well as those who received the neo-adjuvant therapy, compared with the other two groups (P=0.001). The procedure time in the OE group was also shorter by approximately 20 minutes (P=0.021). Total blood loss was significantly lower in the two MIE groups (P=0.004) than in the OE group. There were no differences in the total number of dissected lymph nodes between the three groups (OE: 24.09±10.77, VAMIE: 23.07±10.18, RAMIE: 22.84±8.37, P=0.680). Both the lymph node number (P=0.155) and achievement rate (P=0.190) in the right recurrent laryngeal nerve (RLN) area were comparable between the three groups. However, in the left RLN area, minimally invasive approaches resulted in a higher number of harvested lymph nodes (P=0.032) and greater achievement rate (P=0.018).Neither MIE procedure increased the incidence of postoperative complications. Conclusions: Minimally invasive surgery could guarantee the quality of bilateral RLN lymphadenectomy without increasing postoperative complications, especially in RAMIE patients. The rational choice of different surgical approaches would improve both safety and oncological outcomes for patients.

Robot‐assisted minimally invasive esophagectomy for esophageal cancer: Meticulous surgery minimizing postoperative complications

“…There have been four studies which compared RAMIE and MIE where the methods of recurrent nerve dissection were described in detail and the number of harvested recurrent nerve lymph nodes was five or more. 14,55,60,61 All these studies reported that the rate of recurrent nerve injury is lower in RAMIE than in MIE. Recurrent laryngeal nerve injury leads to serious complications such as aspiration pneumonia.…”

“…Therefore, comparison of recurrent nerve injury rate between the studies does not directly translate into the comparison of the quality of esophageal surgery. There have been four studies which compared RAMIE and MIE where the methods of recurrent nerve dissection were described in detail and the number of harvested recurrent nerve lymph nodes was five or more 14,55,60,61 . All these studies reported that the rate of recurrent nerve injury is lower in RAMIE than in MIE.…”

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

“…Intraoperative outcomes are shown in Figure 7. Operative time was reported by 9 Authors [11,35,37,38,41,45,46,61,63] were performed with a fully robotic approach, except for the study by Rolff et al [45], in which an hybrid procedure (robotic approach to the abdomen and open approach to the thorax) was used. Two articles reported on Ivor-Lewis procedure [37,39], one on McKeown esophagectomy [61] while ten did not provide relevant data to allow subgroup analysis [11,35,41,[44][45][46]52,[62][63][64].…”

“…Operative time was reported by 9 Authors [11,35,37,38,41,45,46,61,63] Postoperative complications are shown in Figure 8. Anastomotic leakage was analysed by 8 Authors [11,35,39,41,44,46,61,63] on 2188 procedures (823 robotic and 1365 open), with no statistical differences between the two approaches (OR = 0.953, p = 0.799, 95%CI 0.655; 1.385) and no significant heterogeneity among the studies (I 2 = 0%, p = 0.556). Postoperative bleeding was reported by 4 Authors [11,46,61,63] on 818 procedures (339 robotic and 479 open), demonstrating no significant differences between the two groups (RD = −0.007, p = 0.372, 95%CI −0.022; 0.008) and no significant heterogeneity among the studies (I 2 = 0%, p = 0.439).…”

Minimally Invasive Esophagectomy In the Modern Era: Is Regional Anesthesia Still the Answer?

“…19 Although MIE traditionally has used videoscopic assistance, robotic techniques currently are being integrated to increase exposure with a 3-dimensional field visualization. 20 Regardless of the chosen method, the bottom line when adopting new surgical approaches is patient outcomes. From a surgical standpoint and despite early skepticism, MIE meets this standard, with potential added benefits including fewer respiratory complications, less blood loss, less pain, earlier oral intake, and enhanced recovery of quality of living.…”