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Perioperative Outcomes and Learning Curve of Robot-Assisted McKeown Esophagectomy

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

This study aimed to evaluate the perioperative outcomes of patients undergoing robot-assisted McKeown esophagectomy (RAME) and the learning curves of surgeons performing RAME at a single center.

Methods

Perioperative outcomes of RAME and video-assisted McKeown esophagectomy (VAME) were compared after eliminating confounding factors by propensity score matching (PSM). The cumulative sum (CUSUM) method was used to evaluate the learning curves of RAME for a single surgical team.

Results

In general, a total of 198 patients with esophageal cancer (RAME: 45 patients, VAME: 153 patients) were included in this study, and 43 pairs of patients receiving RAME or VAME were matched using 1:1 PSM analysis. Those in the RAME group had more lymph nodes dissected in the total lymph nodes (median 29.0 vs. 26.0, P = 0.011) and the upper mediastinum (median 8.0 vs. 6.0, P < 0.001), especially the left recurrent laryngeal nerve (RLN) lymph node (median 4.0 vs. 2.0, P = 0.001). According to the trend of the CUSUM plot, the learning curve was divided into two stages at the 20th RAME procedure. After mastering the learning curve, RAME harvested a significantly higher number of upper mediastinal lymph nodes (median 9.0 vs. 6.0, P = 0.001), left RLN lymph nodes (median 5.0 vs. 3.5, P = 0.003), and right RLN lymph nodes (median 4.0 vs. 2.0, P = 0.002). Meanwhile, the incidence of postoperative pneumonia in the proficiency phase was significantly lower than that in the learning phase (4.0% vs. 25.0%, P = 0.04).

Conclusions

RAME improved left RLN lymph node dissection. Surgeons with extensive VAME experience need at least 20 cases to achieve early proficiency in RAME.

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Funding

This study was funded by the Province-Ministry Co-construction Project of Health Committee of Henan Province (SB201901108), Talent Youth Project of Henan Youth Health Science and Technology Innovation Foundation (YXKC2020022), and Henan Province Key Project of Science and Technology (222102310170).

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Author notes

  1. Hai-Bo Sun and Duo Jiang contributed equally to this work and should be considered co-first author.

Authors and Affiliations

  1. Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China

    Hai-Bo Sun, Duo Jiang, Xian-Ben Liu, Wen-Qun Xing, Shi-Lei Liu, Pei-Nan Chen, Peng Li & Ya-Xing Ma

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  1. Hai-Bo Sun
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  2. Duo Jiang
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Correspondence to Hai-Bo Sun.

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Sun, HB., Jiang, D., Liu, XB. et al. Perioperative Outcomes and Learning Curve of Robot-Assisted McKeown Esophagectomy. J Gastrointest Surg 27, 17–26 (2023). https://doi.org/10.1007/s11605-022-05484-w

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  • DOI: https://doi.org/10.1007/s11605-022-05484-w

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