The modern approach to esophagectomy—review of the shift towards minimally invasive surgery

Background Currently, little is known regarding the optimal technique for the abdominal phase of RAMIE. The aim of this study was to investigate the outcome of robot-assisted minimally invasive esophagectomy (RAMIE) in both the abdominal and thoracic phase (full RAMIE) compared to laparoscopy during the abdominal phase (hybrid laparoscopic RAMIE). Methods This retrospective propensity-score matched analysis of the International Upper Gastrointestinal International Robotic Association (UGIRA) database included 807 RAMIE procedures with intrathoracic anastomosis between 2017 and 2021 from 23 centers. Results After propensity-score matching, 296 hybrid laparoscopic RAMIE patients were compared to 296 full RAMIE patients. Both groups were equal regarding intraoperative blood loss (median 200 ml versus 197 ml, p = 0.6967), operational time (mean 430.3 min versus 417.7 min, p = 0.1032), conversion rate during abdominal phase (2.4% versus 1.7%, p = 0.560), radical resection (R0) rate (95.6% versus 96.3%, p = 0.8526) and total lymph node yield (mean 30.4 versus 29.5, p = 0.3834). The hybrid laparoscopic RAMIE group showed higher rates of anastomotic leakage (28.0% versus 16.6%, p = 0.001) and Clavien Dindo grade 3a or higher (45.3% versus 26.0%, p < 0.001). The length of stay on intensive care unit (median 3 days versus 2 days, p = 0.0005) and in-hospital (median 15 days versus 12 days, p < 0.0001) were longer for the hybrid laparoscopic RAMIE group. Conclusions Hybrid laparoscopic RAMIE and full RAMIE were oncologically equivalent with a potential decrease of postoperative complications and shorter (intensive care) stay after full RAMIE.

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Present and future advances in the treatment of esophagogastric cancer

Bonilla,

Ávila,

Jiménez

et al. 2023

Med.

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El cáncer esofagogástrico es un problema de salud pública a nivel mundial y una de las principales causas de mortalidad principalmente en países de ingresos medios y bajos con aumento importante en lugares con estilos de vida occidental. A pesar de los avances significativos en la última década en relación con biomarcadores y tratamiento, persiste con cifras de supervivencia bajas, lo que indica la necesidad de estrategias de medicina de precisión en terapia dirigida molecularmente. Esta revisión analiza el panorama actual de diagnóstico con perfil molecular y tratamiento en los diferentes escenarios de enfermedad temprana, localmente avanzada y metastásica en cáncer esofagogástrico y los desafíos de los avances a futuro de desarrollo y evolución de nuevos biomarcadores y objetivos terapéuticos emergentes como las técnicas quirúrgicas, el progreso de la radioterapia, terapia dirigida, génica e inmunoterapia, que aumentan la esperanza en el tratamiento y abordaje de estas enfermedades.

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The modern approach to esophagectomy—review of the shift towards minimally invasive surgery

Cited by 3 publications

References 27 publications

Intensive Care of Cancer Patients

Intensive Care of Cancer Patients

Hybrid laparoscopic versus fully robot-assisted minimally invasive esophagectomy: an international propensity-score matched analysis of perioperative outcome

Present and future advances in the treatment of esophagogastric cancer

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