Oncologic Long-Term Results of Robot-Assisted Minimally Invasive Thoraco-Laparoscopic Esophagectomy with Two-Field Lymphadenectomy for Esophageal Cancer

Abstract

BackgroundOpen transthoracic esophagectomy is the worldwide gold standard in the treatment of resectable esophageal cancer. Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy (RAMIE) for esophageal cancer may be associated with reduced blood loss, shorter intensive care unit (ICU) stay, and less cardiopulmonary morbidity; however, long-term oncologic results have not been reported to date.MethodsBetween June 2007 and September 2011, a total of 108 patients with potentially resectable esophageal cancer underwent RAMIE at the University Medical Centre Utrecht, with curative intent. All data were recorded prospectively.ResultsMedian duration of the surgical procedure was 381 min (range 264–636). Pulmonary complications were most common and were observed in 36 patients (33 %). Median ICU stay was 1 day, and median overall postoperative hospital stay was 16 days. In-hospital mortality was 5 %. The majority of patients (78 %) presented with T3 and T4 disease, and 68 % of patients had nodal-positive disease (cN1–3). In 65 % of patients, neoadjuvant treatment (chemotherapy 57 %, chemoradiotherapy 7 %, radiotherapy 1 %) was administered, and in 103 (95 %) patients, a radical resection (R0) was achieved. The median number of lymph nodes was 26, median follow-up was 58 months, 5-year overall survival was 42 %, median disease-free survival was 21 months, and median overall survival was 29 months. Tumor recurrence occurred in 51 patients and was locoregional only in 6 (6 %) patients, systemic only in 31 (30 %) patients, and combined in 14 (14 %) patients.ConclusionRAMIE was shown to be oncologically effective, with a high percentage of R0 radical resections and adequate lymphadenectomy. RAMIE provided good local control with a low percentage of local recurrence at long-term follow up.Electronic supplementary materialThe online version of this article (doi:10.1245/s10434-015-4544-x) contains supplementary material, which is available to authorized users.

Robotic assisted minimally invasive esophagectomy (RAMIE): the University of Pittsburgh Medical Center initial experience

“…The left gastric and short gastric vessels are divided and the gastroepiploic arcade preserved in its entirety during gastric mobilization. Near infrared fluorescence imaging with indocyanine green may be utilized to clearly identify and preserve the gastroepiploic arcade to its termination point (15). In the setting of previous induction chemoradiation therapy, an omental flap based off of 2-3 omental perforating arteries may be harvested for later reinforcement of the gastroesophageal anastomosis.…”

“…Larger single institution series, including from Memorial Sloan Kettering Cancer Center and others, have reported systematic approaches in the development of a robotic assisted minimally invasive esophagectomy (RAMIE) program yielding excellent outcomes with increasing proficiency over the course of the learning curve (13)(14)(15). The primary purported benefit of the robotic assisted approach largely centers around the markedly increased control over the conduct of the operation afforded to the operator over open or alternative minimally invasive operations.…”

Robotic surgery for esophageal cancer: Merits and demerits

“…The Utrecht group, one of the pioneers in this field, reported that, based on 108 cases, their radical resection (R0) rate was 95%, 5‐year overall survival (OS) was 42%, and locoregional recurrence was only 6% 39. The Yonsei group, another pioneer, also reported R0 and 3‐year OS rates of 95.7% and 85%, respectively 40.…”

Current Status and Future Prospects for Esophageal Cancer Treatment

“…In recent years, the usefulness and feasibility of robotic transthoracic esophagectomy for esophageal cancer have been reported. 79,80) Sluis et al 80) reported that robot-assisted minimally invasive thoracolaparoscopic esophagectomy for esophageal cancer has good local control with a low percentage of local recurrence on long-term follow-up. With regard to robotassisted esophagectomy, the further accumulation of patients or a randomized control study will be needed before worldwide adoption.…”