Robotic versus open Ivor–Lewis esophagectomy: A more accurate lymph node dissection without burdening the leak rate

Abstract

Background Robotic‐assisted minimally invasive esophagectomy (RAMIE) combines the beneficial effects of minimally invasive surgery on postoperative complications, especially on pulmonary ones, with the safety of the anastomosis performed in open surgery. Moreover, RAMIE could allow a more accurate lymphadenectomy. Methods We reviewed our database to identify all patients with adenocarcinoma of the esophagus treated by Ivor–Lewis esophagectomy in the period January 2014 to June 2022. Patients were divided according to the thoracic approach into RAMIE and open esophagectomy (OE) groups. We compared the groups for early surgical outcomes, 90‐day mortality as well as R0 rate, and the number of lymph nodes harvested. Results We identified 47 patients in RAMIE and 159 patients in the OE group. Baseline characteristics were comparable. Operative time was significantly longer for RAMIE procedures (p < 0.01); however, we did not observe the difference in overall (RAMIE 55.5% vs. OE 61%, p = 0.76) and severe complications rate (RAMIE 17% vs. OE 22.6%, p = 0.4). The anastomotic leak rate was 2.1% after RAMIE and 6.9% after OE (p = 0.56). We did not report the difference in 90‐day mortality (RAMIE 2.1% vs. OE 1.9%, p = 0.65). In the RAMIE group, we observed a significantly higher number of thoracic lymph nodes harvested, with a median of 10 lymph nodes in the RAMIE group versus 8 in the OE group (p < 0.01). Conclusions In our experience, RAMIE has morbimortality rates comparable to OE. Moreover, it allows a more accurate thoracic lymphadenectomy which results in a higher thoracic lymph nodes retrieval rate.

A minimally invasive esophagectomy; by any means necessary

“…We are now awaiting the results of the upcoming ROBOT‐2 trial comparing standard minimally invasive esophagectomy to robotic‐assisted minimally invasive esophagectomy, where the primary endpoint is in regard to improved lymph node dissection and sampling 12 . The current paper draws attention to the greater number of lymph nodes harvested in the chest portion of the operation with the robotic approach, however, the total number of lymph nodes between the two groups is not significantly different 1 . As the esophagus traverses between two body cavities, the potential for metastatic spread in both the chest and abdominal lymph node basins is equally clinically relevant.…”

“…Matthew Rochefort MD Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA I would like to commend Drs Weindelmayer et al, 1 on their welldesigned and completed study in the current edition of Journal of Surgical Oncology. The main objective of this study was to compare the impact of a minimally invasive robotic-assisted Ivor-Lewis esophagectomy compared with an Open Esophagectomy on early surgical outcomes, 90-day mortality, and the overall quality of the surgical resection.…”

“…The main objective of this study was to compare the impact of a minimally invasive robotic-assisted Ivor-Lewis esophagectomy compared with an Open Esophagectomy on early surgical outcomes, 90-day mortality, and the overall quality of the surgical resection. 1 The article evaluated 206 patients, at a single institution, operated on between 2014 and 2022. They concluded that there was no difference in the morbidity or mortality experienced between the robotic and open esophagectomy cohorts, however, there was a trend towards a more extensive mediastinal lymph node dissection.…”

“…12 The current paper draws attention to the greater number of lymph nodes harvested in the chest portion of the operation with the robotic approach, however, the total number of lymph nodes between the two groups is not significantly different. 1 As the esophagus traverses between two body cavities, the potential for metastatic spread in both the chest and abdominal lymph node basins is equally clinically relevant.…”

“…I would like to commend Drs Weindelmayer et al, 1 on their well‐designed and completed study in the current edition of Journal of Surgical Oncology. The main objective of this study was to compare the impact of a minimally invasive robotic‐assisted Ivor‐Lewis esophagectomy compared with an Open Esophagectomy on early surgical outcomes, 90‐day mortality, and the overall quality of the surgical resection 1 . The article evaluated 206 patients, at a single institution, operated on between 2014 and 2022.…”