Early Experience of Robot-Assisted Esophagectomy With Circular End-to-End Stapled Anastomosis

Wee, Jon O.; Bravo‐Iñiguez, Carlos E.; Jaklitsch, Michael T.

doi:10.1016/j.athoracsur.2016.02.050

Cited by 33 publications

(21 citation statements)

References 26 publications

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“…To explore the possibility that studies with nonsignificant results (no effect of AF) were not being published, a funnel plot analysis was done. No publication bias was detected in terms of postoperative (within 30 days) Mc Cormack et al 60 Chin et al 58 Wee et al 63 Mao et al 46 Guven et al 62 Ojima et al 15 Seesing et al 28 Pan et al 44 Ojima et al 13 Fei Yao et al 49 Shridhar et al 45 Rao et al 55 Merritt et al 31 Hua et al 52 Stawicki et al 30 Feng et al 51 Kernstine et al 34 Seely et al 47 Ma et al 32 Overall ( Mc Cormack et al 60 Wee et al 63 Mao et al 46 Guven et al 62 Ojima et al 15 Seesing et al 28 Pan et al 44 Wang et al 64 Yao et al 49 Shridhar et al 45 Yoshida et al 12 Hou et al 33 Collins et al 35 Feng et al 51 Kernstine et al 34 Murthy et al 36 Ma et al 32 Overall (I 2 = 34·7%, P = 0·079)…”

Section: Odds Ratio Odds Ratio Weight (%)mentioning

confidence: 98%

Meta-analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy

Schizas

Kosmopoulos

Giannopoulos

et al. 2019

British Journal of Surgery

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Background: Oesophagectomy is associated with high morbidity and mortality rates. New-onset atrial fibrillation (AF) is a frequent complication following oesophagectomy. Several studies have explored whether new-onset AF is associated with adverse events after oesophagectomy.Methods: This review was performed according to PRISMA guidelines. Eligible studies were identified through a search of PubMed, Scopus and Cochrane CENTRAL databases up to 25 November 2018. A meta-analysis was conducted with the use of random-effects modelling. The I 2 statistic was used to assess for heterogeneity.Results: In total, 53 studies including 9087 patients were eligible for analysis. The overall incidence of postoperative AF was 16⋅5 per cent. Coronary artery disease and hypertension were associated with AF, whereas diabetes, smoking and chronic obstructive pulmonary disease were not. Patients with AF had a significantly higher risk of overall postoperative adverse events than those without fibrillation (odds ratio (OR) 5⋅50, 95 per cent c.i. 3⋅51 to 8⋅30), including 30-day mortality (OR 2⋅49, 1⋅70 to 3⋅64), anastomotic leak (OR 2⋅65, 1⋅53 to 4⋅59) and pneumonia (OR 3⋅42, 2⋅39 to 4⋅90).Conclusion: Postoperative AF is frequently observed in patients undergoing oesophagectomy for cancer. It is associated with an increased risk of death and postoperative complications.

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Section: Odds Ratio Odds Ratio Weight (%)mentioning

confidence: 98%

Meta-analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy

Schizas

Kosmopoulos

Giannopoulos

et al. 2019

British Journal of Surgery

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“…A total of nine published papers reported initial cases of transthoracic esophagectomy (TTE) 14, 15, 16, 17, 18, 19, 20, 21, 22. Numbers of patients ranged from 14 to 50, in total 224 cases; mean operative time, estimated blood loss, length of hospital stay, and lymph node yield were 466 min (210–666), 296 mL (80–950), 11.7 days (8–21), and 21.4 (18–38), respectively.…”

Section: Early Results With Small Series Of Transthoracic Esophagectomymentioning

confidence: 99%

Robotic surgery for esophageal cancer: Merits and demerits

Seto

Mori

Aikou

2017

Annals of Gastroent Surgery

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Since the introduction of robotic systems in esophageal surgery in 2000, the number of robotic esophagectomies has been gradually increasing worldwide, although robot‐assisted surgery is not yet regarded as standard treatment for esophageal cancer, because of its high cost and the paucity of high‐level evidence. In 2016, more than 1800 cases were operated with robot assistance. Early results with small series demonstrated feasibility and safety in both robotic transhiatal (THE) and transthoracic esophagectomies (TTE). Some studies report that the learning curve is approximately 20 cases. Following the initial series, operative results of robotic TTE have shown a tendency to improve, and oncological long‐term results are reported to be effective and acceptable: R0 resection approaches 95%, and locoregional recurrence is rare. Several recent studies have demonstrated advantages of robotic esophagectomy in lymphadenectomy compared with the thoracoscopic approach. Such technical innovations as three‐dimensional view, articulated instruments with seven degrees of movement, tremor filter etc. have the potential to outperform any conventional procedures. With the aim of preventing postoperative pulmonary complications without diminishing lymphadenectomy performance, a nontransthoracic radical esophagectomy procedure combining a video‐assisted cervical approach for the upper mediastinum and a robot‐assisted transhiatal approach for the middle and lower mediastinum, transmediastinal esophagectomy, was developed; its short‐term outcomes are promising.Thus, the merits or demerits of robotic surgery in this field remain quite difficult to assess. However, in the near future, the merits will definitely outweigh the demerits because the esophagus is an ideal organ for a robotic approach.

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“…Length of stay was 8 days, and 85% of patients were discharged to home. Overall operative time was long at 455 minutes, but this may be related to the learning curve (4).…”

Section: Clinical Resultsmentioning

confidence: 99%

Minimally invasive esophagectomy: the Brigham and Women’s Hospital experience

Wee

Bueno

Swanson

2017

Ann. Cardiothorac. Surg.

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A 68-year-old male presented with a long history of recurrent dysphagia secondary to Schatzki's ring for which he had previously required endoscopy and dilations in the past. He again developed symptoms of dysphagia that had progressed over several months resulting in a 15 pound weight loss and chronic fatigue. He had a barium swallow study that demonstrated a large mass causing partial obstruction in the distal esophagus as well as small hiatal hernia. Endoscopy demonstrated a large mass in the distal esophagus occupying nearly the entire lumen and was friable and with necrosis. The stomach and duodenum appeared normal. Biopsies of the esophageal mass demonstrated poorly differentiated adenocarcinoma, HER-2/neu positive. A computed tomography (CT) scan of the chest, abdomen and pelvis demonstrated a distal esophageal mass measuring 6.5 cm in length by 4.2 cm × 4.4 cm. The proximal esophagus above the mass was distended, but there was no evidence of any mediastinal, hilar or axillary lymphadenopathy. He had an endoscopic ultrasound that demonstrated a hypoechoic lesion that went through the muscularis propria measuring 3.1 cm × 3.8 cm. It was obstructing the lumen of the esophagus and the scope could not be advanced distally. He was staged at least a T3 Nx lesion. A positron emission tomography (PET) CT on 06/23/2016 demonstrated markedly hypermetabolic mass in the distal esophagus with SUVmax of 13.5. He underwent chemoradiotherapy neoadjuvant setting with cisplatin and etoposide and 5,040 cGy of XRT. Repeat PET/CT demonstrated some persistent avidity in the lower esophagus, but no additional activity. We proceeded onto surgical resection. Surgical technique PreparationPatients are given a clear liquid diet 24 hours preoperatively. We do not give a formal bowel prep as this leads to dehydration post-operatively. ExpositionOur approach is a minimally invasive Ivor Lewis e s o p h a g e c t o m y s t a r t i n g i n t h e s u p i n e p o s i t i o n laparoscopically, and then transitioning to a left laterally decubitus position for the chest direction. A foot board is utilized to allow for a step reverse trendelenburg position for laparoscopy.

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Early Experience of Robot-Assisted Esophagectomy With Circular End-to-End Stapled Anastomosis

Abstract: RAILE-EEA in our institution suggests a safe, effective, and reproducible alternative with satisfactory postoperative outcomes for the treatment of esophageal cancer. It provided good local control, adequate lymphadenectomy, low morbidity, and low 90-day operative mortality.

Cited by 33 publications

References 26 publications

Meta-analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy

Meta-analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy

Robotic surgery for esophageal cancer: Merits and demerits

Minimally invasive esophagectomy: the Brigham and Women’s Hospital experience

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