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Comparative outcomes of minimally invasive and robotic-assisted esophagectomy

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Abstract

Objective

Minimally invasive esophagectomy (MIE) has demonstrated superior outcomes compared to open approaches. The myriad of techniques has precluded the recommendation of a standard approach. The addition of robotics to esophageal resection has potential benefits. We sought to examine the outcomes with MIE to include robotics.

Methods

Utilizing a prospective esophagectomy database, we identified patients who underwent (MIE) Ivor Lewis via thoracoscopic/laparoscopic (TL), transhiatal (TH), or robotic-assisted Ivor Lewis (RAIL). Patient demographics, tumor characteristics, and complications were analyzed via ANOVA, χ2, and Fisher exact where appropriate.

Results

We identified 302 patients who underwent MIE: TL 95 (31.5%), TH 63 (20.8%), and RAIL 144 (47.7%) with a mean age of 65 ± 9.6. The length of operation was longer in the RAIL: TL (299 ± 87), TH (231 ± 65), RAIL (409 ± 104 min), p < 0.001. However, the EBL was lower in the patients undergoing transthoracic approaches (RAIL + TL): TL (189 ± 188 ml), TH (242 ± 380 ml), RAIL (155 ± 107 ml), p = 0.03. Conversion to open was also lower in these patients: TL 7 (7.4%), TH 8 (12.7%), RAIL 0, p < 0.001. The R0 resection rate and lymph node (LN) harvest also favored the RAIL cohort: TL 86 (93.5%), TH 60 (96.8%), and RAIL 144 (100%), p = 0.01; LN: TL 14 ± 7, TH 9 ± 6, and RAIL 20 ± 9, p < 0.001. The overall morbidity was lower in MIE patients that underwent a transthoracic approach vs. transhiatal: TL 29 (30.5%), TH 39 (61.9%), RAIL 34 (23.6%), p < 0.001.

Conclusions

Patients undergoing MIE via thoracoscopic/laparoscopic and robotic transthoracic approaches demonstrated lower EBL, morbidity, and conversion to open compared to the transhiatal approach. Additionally the oncologic outcomes measured by R0 resections and LN harvest also favored the patients who underwent a transthoracic approach.

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Author information

CT: Concept and design, data analysis, manuscript writing, and final approval. RS: Concept and design, data analysis and interpretation, manuscript writing, and final approval. JH: Collection and assembly of data and final approval. KM: Concept and design, data analysis and interpretation, manuscript writing, and final approval. PB: Data analysis, manuscript writing, and final approval. TM: Data analysis, manuscript writing, and final approval.

Correspondence to Kenneth Meredith.

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Disclosures

Dr. Meredith, Dr. Takahashi, Dr. Shridhar, Ms. Blinn, Ms. Maramara, and Ms. Huston have no conflicts of interest or financial ties to disclose.

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Meredith, K., Blinn, P., Maramara, T. et al. Comparative outcomes of minimally invasive and robotic-assisted esophagectomy. Surg Endosc 34, 814–820 (2020). https://doi.org/10.1007/s00464-019-06834-7

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Keywords

  • Transhiatal esophagectomy
  • Transthoracic esophagectomy
  • Robotic esophagectomy