Robot-assisted minimally invasive esophagectomy versus video-assisted minimally invasive esophagectomy: a systematic review and meta-analysis

Abstract

Background Robot-assisted minimally invasive esophagectomy (RAMIE) has been demonstrated to offer realistic three-dimensional visual clarity, flexible movement and so on. The high cost is the main reason hampering universal application. The aim of this study was to compare the short-term outcomes of RAMIE versus video-assisted minimally invasive esophagectomy (VAMIE). Methods The PubMed, EMBASE and Web of Science databases were systematically searched up to June 1, 2021, for studies comparing RAMIE and VAMIE. Results Nineteen studies were enrolled, which consisted of a total of 4,714 patients, including 2,306 patients in the RAMIE group and 2,408 patients in the VAMIE group. In RAMIE patients, higher numbers of total lymph nodes (MD =0.171, 95% CI: 0.086–0.255, P<0.001) and lymph nodes along the left recurrent laryngeal nerve (RLN) (MD =0.219, 95% CI: 0.097–0.340, P<0.001) were removed. In RAMIE patients in the McKown group, higher numbers of total lymph nodes (MD =0.173, 95% CI: 0.080–0.265, P<0.001) and lymph nodes along the left RLN (MD =0.220, 95% CI: 0.090–0.350, P=0.001) were removed, while in those in the ESCC group, higher numbers of total lymph nodes (MD =0.249, 95% CI: 0.091–0.407, P=0.002) and lymph nodes along the left RLN (MD =0.239, 95% CI: 0.102–0.377, P=0.001) were removed. Discussion This study indicated that the main advantage of RAMIE was a greater number of harvested lymph nodes, which may be beneficial to diagnosis and local control. RCTs with larger sample sizes and studies reporting long-term outcomes are needed to evaluate the advantages and disadvantages of RAMIE and VAMIE.

The Implementation of Minimally Invasive Surgery in the Treatment of Esophageal Cancer: A Step Toward Better Outcomes?

“…The RAMIE, ROBOT-2, and REVATE trials will enlighten this discussion in the future [ 21 , 25 , 26 ]. Hence, the enhanced view during abdominal and mediastinal laparoscopic, thoracoscopic, or robotic lymphadenectomy and the meticulous dissection regarding the primary tumor and the fields of lymphadenectomy have the potential to increase the number of resected lymph nodes, as clearly shown in previously published studies [ 27 , 28 , 30 ].…”

“…Such a retrospective American analysis compared 100 RAMIE cases with 625 MIE cases, finding no substantial differences in the short-term postoperative period [ 29 ]. Similarly, 19 retrospective studies were discussed in a systematic review and meta-analysis in 2021, and again, apart from the higher number of resected lymph nodes, MIE and RAMIE presented equal perioperative results [ 30 ].…”

The evolution of anastomotic techniques in robot-assisted Ivor Lewis esophagectomy

“…Furthermore, a meta-analysis collected the results of eight case-control studies and resulted in similar results between MIE and RAMIE [17] . In the past, other non-randomised studies have also shown no clearly significant superiority of RAMIE over MIE; however, a trend towards more radical lymph node dissections in RAMIE patients has been reported [18][19][20] .…”

Robotic-Assisted Esophagectomy: Current Situation and Future Perspectives

“…We summarized differences in the operative and postoperative outcomes between RAMIE and MIE or OE in Tables 2 and 3. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] Concerning this issue, we found 12 meta-analyses and 2 RCTs. In many studies, operation time was longer in RAMIE than in OE or MIE.…”

“…As oncologic variables, several authors compared the R0 resection rate and the number of lymph nodes harvested. Concerning the oncologic comparisons, we collected 10 meta-analyses [11][12][13][14]16,[18][19][20][21][22] and 2 RCTs (Table 4). 23,24) Two meta-analyses demonstrated better R0 resection rates in RAMIE compared to conventional MIE.…”