Robot-assisted esophagectomy may improve perioperative outcome in patients with esophageal cancer – a single-center experience

Abstract

BackgroundAlthough the introduction of minimally invasive surgical techniques has improved surgical outcomes in recent decades, esophagectomy for esophageal cancer is still associated with severe complications and a high mortality rate. Robot-assisted surgery is already established in certain fields and robot-assisted esophagectomy may be a possible alternative to the standard minimally invasive esophagectomy. The goal of this study was to investigate whether robot assistance in esophagectomy can improve patient outcome while maintaining good oncological control.Material and methodsData of all patients who underwent minimally invasive esophagectomy between January 2018 and November 2021 at University Hospital Mannheim was collected retrospectively. Patients were divided into two cohorts according to operative technique (standard minimally invasive (MIE) vs. robot-assisted esophagectomy (RAMIE), and their outcomes compared. In a separate analysis, patients were propensity score matched according to age, gender and histological diagnosis, leading to 20 matching pairs.Results95 patients were included in this study. Of those, 71 patients underwent robot-assisted esophagectomy and 24 patients underwent standard minimally invasive esophagectomy. Robot-assisted esophagectomy showed a lower incidence of general postoperative complications (52.1% vs. 79.2%, p=0.0198), surgical complications (42.3% vs. 75.0%, p=0.0055), a lower rate of anastomotic leakage (21.1% vs. 50.0%, p=0.0067), a lower Comprehensive Complication Index (median of 20.9 vs. 38.6, p=0.0065) as well as a shorter duration of hospital stay (median of 15 vs. 26 days, p=0.0012) and stay in the intensive care unit (median of 4 vs. 7 days, p=0.028) than standard minimally invasive surgery. After additionally matching RAMIE and MIE patients according to age, gender and diagnosis, we found significant improvement in the RAMIE group compared to the MIE group regarding the Comprehensive Complication Index (median of 20.9 vs. 38.6, p=0.0276), anastomotic leakage (20% vs. 55%, p=0.0484) and severe toxicity during neoadjuvant treatment (0 patients vs. 9 patients, p=0.005).ConclusionRobot-assisted surgery can significantly improve outcomes for patients with esophageal cancer. It may lead to a shorter hospital stay as well as lower rates of complications, including anastomotic leakage.

Is Robotic Surgery the Future for Resectable Esophageal Cancer?: A Systematic Literature Review of Oncological and Clinical Outcomes

“…Factors contributing to reduced LoS include less postoperative pain and nausea, earlier introduction of oral intake, and mobilisation. 5 , 81 , 86 Enhanced Recovery After Surgery (ERAS) programmes or ‘fast-track protocols’ in elective upper GI resection have led to improvements in patient outcomes, including LoS and postoperative morbidity, by implementing a standardised pathway for patients and care providers. 87 , 88 No studies commented on the use of ERAS.…”

Feasibility and safety of expandable mediastinoscopic and laparoscopic radical esophagectomy

“…It was also superior to thoracotomy and VATLE, which have been reported in the past; this was helped by the fact that transmediastinal endoluminal surgery can significantly reduce the impact on the lungs ( 2 , 13 ). We summarized perioperative data such as postoperative complications, conversion rate to thoracotomy, in-hospital mortality, and postoperative hospital stay, and did not find that EMLE was inferior to other surgical methods, even robot-assisted surgery ( 8 , 14 ). In terms of the incidence of RLN palsy and chylothorax after surgery, our data were better than some of the reported literature data ( 12 ), which may be because of two reasons: (i) the clear vision and wide exposure of the expandable mediastinoscopic system during the surgery, and (ii) the rich experience accumulated over a prolonged period by our medical center with respect to operating using a mediastinoscope.…”

“…Because of these problems, some surgeons began to try to change the original surgical methods to diversify the surgical methods of esophageal cancer (5)(6)(7)(8)(9), so that thoracic surgeons can have more choices for patients with esophageal cancer under different conditions and improve the overall prognosis. Based on the development of mediastinoscopic technology, minimally invasive esophageal surgery, and video-assisted mediastinoscope, our team successfully developed a new surgical method in 2019, namely the expandable mediastinoscopic and laparoscopic radical esophagectomy (EMLE) approach.…”

A comparative study of robotic surgery and thoracoscopic surgery for mediastinal cysts

“…With the rapid development of surgical instruments, RATS has been used increasingly in clinical applications. Compared with VATS, RATS has been widely used for esophagectomy, lobectomy, and other thoracic surgeries due to its advantages in automatic tremor ltering, three-dimensional eld of view, 10-fold magni ed images, and 7 degrees of freedom of rotation [3][4][5], whereas scarce investigations on RATS for resection of mediastinal cysts have been reported. This study retrospectively analyzed the clinical data of 70 cases of minimally invasive surgery for mediastinal cysts completed at our center from April 2014 to December 2022, including 37 cases in the RATS group and 38 cases in the VATS group, to evaluate the safety and e cacy of RATS.…”