Propensity‐Matched Analysis of the Short‐Term Outcome of Robot‐Assisted Minimally Invasive Esophagectomy Versus Conventional Thoracoscopic Esophagectomy in Thoracic Esophageal Cancer

Fujita, Takeo; Sato, Kazuma; Ozaki, Asako; Akutsu, Tomohiro; Fujiwara, Hisashi; Kojima, Takashi; Daiko, Hiroyuki

doi:10.1007/s00268-022-06567-0

Cited by 9 publications

(4 citation statements)

References 31 publications

(27 reference statements)

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“…Furthermore, robotic surgery technology has been recently introduced for esophageal cancer surgery and is gradually becoming popular worldwide [ 26 , 27 ]. By making good use of the multi-joint function of robotic arms, it is possible for a surgeon to gently manipulate organs and tissues during mediastinal dissection and maintain the operative field by themselves and may alleviate the procedural difficulty of MIE.…”

Section: Discussionmentioning

confidence: 99%

Analysis of factors associated with operative difficulty in thoracoscopic esophageal cancer surgery in the left-decubitus position: a single-center retrospective study

Okamoto,

Inaki,

Saito

et al. 2023

BMC Surg

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Background The degree of difficulty in the overall procedure and forceps handling encountered by surgeons is greatly influenced by the positional relationship of intrathoracic organs in minimally invasive esophagectomy. This study aimed to identify the anatomical factors associated with the difficulty of minimally invasive esophagectomy assessed by intraoperative injuries and postoperative outcomes. Methods Minimally invasive esophagectomy in the left-decubitus position was performed in 258 patients. We defined α (mm) as the anteroposterior distance between the front of the vertebral body and aorta, β (mm) as the distance between the center of the vertebral body and center of the aorta, and γ (degree) as the angle formed at surgeon’s right-hand port site by insertion of lines from the front of aorta and from the front of vertebrae in the computed tomography slice at the operator’s right-hand forceps hole level. We retrospectively analyzed the correlations among clinico-anatomical factors, surgeon- or assistant-caused intraoperative organ injuries, and postoperative complications. Results Intraoperative injuries significantly correlated with shorter α (0.2 vs. 3.9), longer β (33.0 vs. 30.5), smaller γ (3.0 vs. 4.3), R1 resection (18.5% vs. 8.3%), and the presence of intrathoracic adhesion (46% vs. 26%) compared with the non-injured group. Division of the median values into two groups showed that shorter α and smaller γ were significantly associated with organ injury. Longer β was significantly associated with postoperative tachycardia onset, respiratory complications, and mediastinal recurrence. Furthermore, the occurrence of intraoperative injuries was significantly associated with the onset of postoperative pulmonary complications. Conclusions Intrathoracic anatomical features greatly affected the procedural difficulty of minimally invasive esophagectomy, suggesting that preoperative computed tomography simulation and appropriate port settings may improve surgical outcomes.

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Section: Discussionmentioning

confidence: 99%

Analysis of factors associated with operative difficulty in thoracoscopic esophageal cancer surgery in the left-decubitus position: a single-center retrospective study

Okamoto,

Inaki,

Saito

et al. 2023

BMC Surg

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“…Thus, robotassisted surgery was recognized to be useful, providing precise lymphadenectomy with less bleeding (3). In addition, compared to conventional endoscopic surgery, RAMIE was reported to have equivalent oncological outcomes and lower incidence of morbidity (4,5).…”

Section: Review Articlementioning

confidence: 99%

Features and applications of energy devices for prone robot-assisted minimally invasive esophagectomy: a narrative review

Hirahara¹,

Matsubara²,

Hayashi³

et al. 2022

J Thorac Dis

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Background and Objective: Robot-assisted surgery is particularly useful in esophagectomy for esophageal cancer because robotic systems have high-resolution three-dimensional imaging, tremor filtering, and articulated instruments. This review article focuses on the applications and limitations of surgical devices in robot-assisted minimally invasive esophagectomy (RAMIE).Methods: A narrative search of Medline was performed for articles published using the keywords "robotassisted esophagectomy", "technique", "postoperative complication", and "short-term outcomes".Key Contents and Findings: Monopolar scissors: these devices with a sharp tip have an articulating function that allows for fast, sharp dissection without an electrical source. However, scissor-type devices cannot compress the organ, and their hemostatic ability is rather weak. Maryland bipolar forceps: the device has a very thin tip that allows for accurate dissection as well as stronger hemostatic ability by closing the forceps to compress tissues and applying electric current. The disadvantage is longer operation time because the forceps need to be constantly closed and reopened. Long Maryland bipolar grasper: the tip of the long Maryland bipolar grasper is slightly blunt and has the advantage of versatility because it can grip the tissue more delicately. Ultrasonic scalpel: the device can transect tissues speedily without bleeding, shortening operation time, but lacks articulating function. Although thermal spread to the surroundings is relatively narrow, activation time increases with the amount of tissue to be grasped; this raises the temperature above that of the vessel sealer. Vessel sealer: the device is one of the most powerful hemostatic energy devices, based on bipolar electrodes. The articulating jaws on both sides are more suited for sharp transection rather than meticulous dissection because of its powerful hemostatic force and blunt tip. It is also important to note that the vessel sealer produces widespread high-temperature steam. SynchroSeal: the device offers fast activation time, and due to the tip of the device being finely divided, which requires relatively precise manipulation.Conclusions: Robot-assisted surgery reduces the limitations of conventional endoscopic surgery by offering stable high-resolution three-dimensional imaging, tremor filtering, and articulated instruments. It is important to understand and exploit the advantages of energy devices suitable for RAMIE.

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“…Esophageal cancer (EC) is the seventh commonest malignancy worldwide [1]. Despite recent improvements in surgical procedures and perioperative management [2], esophagectomy for EC is known as highly invasive and poses a high incidence of postoperative complications and mortality [3].…”

Section: Introductionmentioning

confidence: 99%

A Novel Frailty Grade Combined with Cachexia Index and Osteopenia in Esophagectomy

et al. 2023

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Backgrounds The optimal method for evaluating frailty grade in patients with cancer has not been established in patients undergoing esophagectomy for esophageal cancer. This study aimed to clarify the impact of cachexia index (CXI) and osteopenia on survival in esophagectomized patients for esophageal cancer to develop frailty grade for risk stratification of the prognosis. Methods A total of 239 patients who underwent esophagectomy were analyzed. CXI was calculated as follows: skeletal muscle index 9 serum albumin/neutrophil-to-lymphocyte ratio. Meanwhile, osteopenia was defined as below the cutoff value of bone mineral density (BMD) calculated by the receiver operating characteristic curve. We evaluated the average Hounsfield unit within a circle in the lower midvertebral core of the 11th thoracic vertebra on preoperative computed tomography as BMD.Results Multivariate analysis revealed that low CXI (Hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.25-3.04) and osteopenia (HR, 1.86; 95% CI, 1.19-2.93) were independent prognostic factors for overall survival. Meanwhile, low CXI (HR, 1.58; 95% CI, 1.06-2.34) and osteopenia (HR, 1.57; 95% CI, 1.05-2.36) were also significant prognostic factors for relapse-free survival. A frailty grade combined with CXI and osteopenia stratified into four groups by their prognosis. Conclusions Low CXI and osteopenia predict poor survival in patients undergoing esophagectomy for esophageal cancer. Furthermore, a novel frailty grade combined with CXI and osteopenia stratified the patients into four groups according to their prognosis.

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Propensity‐Matched Analysis of the Short‐Term Outcome of Robot‐Assisted Minimally Invasive Esophagectomy Versus Conventional Thoracoscopic Esophagectomy in Thoracic Esophageal Cancer

Cited by 9 publications

References 31 publications

Analysis of factors associated with operative difficulty in thoracoscopic esophageal cancer surgery in the left-decubitus position: a single-center retrospective study

Analysis of factors associated with operative difficulty in thoracoscopic esophageal cancer surgery in the left-decubitus position: a single-center retrospective study

Features and applications of energy devices for prone robot-assisted minimally invasive esophagectomy: a narrative review

A Novel Frailty Grade Combined with Cachexia Index and Osteopenia in Esophagectomy

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