Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer: A randomized controlled trial.

Abstract

6 Background: The standard curative treatment for patients with esophageal cancer is perioperative chemotherapy or preoperative chemoradiotherapy followed by open transthoracic esophagectomy (OTE). Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy (RAMIE) may reduce perioperative complications and improve functional recovery. Methods: In this randomized controlled trial, 112 patients with resectable intrathoracic esophageal cancer were randomly assigned to RAMIE or OTE. The composite primary endpoint was the occurrence of overall postoperative complications (modified Clavien–Dindo classification (MCDC) grade 2-5). Results: Postoperative complications occurred less frequently after RAMIE (59%) compared to OTE (80%) (RR 0.74 (0.57-0.96; P = 0.02). RAMIE resulted in a less median blood loss (400ml versus 568ml, P < 0.001), a lower percentage of surgery-related complications (RR 0.74 (0.57-0.96; P = 0.02), pulmonary complications (RR 0.54 (0.34-0.85; P = 0.005) and cardiac complications (RR 0.47 (0.27-0.83; P = 0.006)) and lower mean postoperative pain (visual analogue scale, 1.86 versus 2.62; p < 0.000) compared to OTE. Functional recovery at postoperative day 14 was better in the RAMIE group (RR 1.48 (1.03–2.13; P = 0.038)) with better quality of life score at discharge (mean difference quality of life score 13.4 (2.0-24.7, p = 0.02) and 6 weeks post-discharge (mean difference 11.1 quality of life score (1.0-21.1; p = 0.03)). Mean costs for RAMIE were €34.892 and mean costs for OTE were €39.463 (p = 0.07). Oncological outcomes at short term (radicality, number of lymph nodes) and long term (overall and disease-free survival) were equal at a medium follow up of 38 months. Conclusions: RAMIE resulted in a lower percentage of overall, surgery-related and (cardio)pulmonary complications with lower postoperative pain, better quality of life and a better short term postoperative functional recovery compared to OTE. Oncological outcomes were equal. This randomized controlled trial provides evidence for the use of RAMIE to improve postoperative outcome in patients with resectable esophageal cancer. Clinical trial information: NCT01544790.

Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer

“…Other inclusion criteria were: oesophagectomy scheduled at least 2 weeks after the baseline measurement, a good understanding of the instructions of IMT and ability to perform the IMT programme. Exclusion criteria were: unable to communicate in the mother language spoken at the participating centre, age less than 18 years and participation in another trial with similar endpoints 20,21 .…”

Robotic surgery for upper gastrointestinal cancer: Current status and future perspectives

“…Since 2012, a prospective randomized clinical trial comparing robot-assisted minimally invasive thoracolaparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer (RO-BOT trial) has been conducted in order to determine whether RE will reduce postoperative complications, blood loss, and hospital stay, being associated with at least similar oncological outcomes and better postoperative quality of life in comparison with open transthoracic esophagectomy. 72 Further studies are warranted to determine advantages and disadvantages of RE.…”

Total (Transthoracic and Transabdominal) Robotic Radical Three-Stage Esophagectomy—Initial Indian Experience

“…Therefore, robot-assisted three-stage esophagectomy is a safe and feasible technique for the treatment of esophageal cancer in selected patients. However, results of a randomized trial with long-term oncological outcomes (ROBOT trial) are awaited in this regard [10].…”

“…Noshiro et al [7] and Fabian et al [8] in their comparison of prone versus left lateral decubitus position during thoracoscopic esophageal mobilization found many advantages with prone position. In thoracic-phase port placement, Boone et al [9] and van der Sluis et al [10] have reported the use of two assistant ports in the left lateral decubitus position. We used one assistant port with ease in the prone position, as is reported by Kim et al [11].…”