Skip to main content

Advertisement

SpringerLink
Log in

Robotic esophagectomy: results from a tertiary care Italian center

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

There is growing evidence supporting the use of minimally invasive resection in esophageal surgery, mainly due to reduced postoperative morbidity and faster recovery after surgery. In recent years, robot-assisted surgery has shown some potential benefits over conventional laparo-thoracoscopic esophagectomy. The purpose of this study is to report our experience with different esophageal resections with a full-robotic approach for malignant disease. All consecutive patients with resectable esophageal malignancy undergoing robotic esophagectomy over a 6-year time frame by a single surgical team were included in this analysis. Perioperative and clinicopathological outcomes were assessed. A total of 76 patients received robotic esophagectomy. Surgeries included 45 Lewis procedures, 25 McKeown procedures, and six transhiatal resections. There were no intraoperative complications and no conversions occurred. The rate of postoperative morbidity was 41%, while the rate of anastomotic leak was 13%. Overall, eight patients required reintervention. All patients received R0 resection, with a median of harvested lymph nodes of 35. 30-day and 90-day mortality was 3.9 and 7.9%, respectively. Our findings support the safety and oncological efficiency of full-robotic esophagectomy. All procedures of esophageal resection were associated with the expected perioperative morbidity while providing excellent pathological outcomes for patients with malignancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

Data analysis available upon specific request.

References

  1. Cuesta MA, van der Wielen N, Straatman J, van der Peet DL (2016) Video-assisted thoracoscopic esophagectomy: keynote lecture. Gen Thorac Cardiovasc Surg 64:380–385

    Article  PubMed  PubMed Central  Google Scholar 

  2. Low DE, Kuppusamy MK, Alderson D, Cecconello I, Chang AC, Darling G, Davies A, D’Journo XB, Gisbertz SS, Griffin SM, Hardwick R, Hoelscher A, Hofstetter W, Jobe B, Kitagawa Y, Law S, Mariette C, Maynard N, Morse CR, Nafteux P, Pera M, Pramesh CS, Puig S, Reynolds JV, Schroeder W, Smithers M, Wijnhoven BPL (2019) Benchmarking complications associated with esophagectomy. Ann Surg 269:291–298

    Article  PubMed  Google Scholar 

  3. Pointer DT Jr, Saeed S, Naffouje SA, Mehta R, Hoffe SE, Dineen SP, Fleming JB, Fontaine JP, Pimiento JM (2020) Outcomes of 350 robotic-assisted esophagectomies at a high-volume cancer center: a contemporary propensity-score matched analysis. Ann Surg. https://doi.org/10.1097/SLA.0000000000004317 (Epub ahead of print)

    Article  PubMed  Google Scholar 

  4. Ali AM, Bachman KC, Worrell SG, Gray KE, Perry Y, Linden PA, Towe CW (2020) Robotic minimally invasive esophagectomy provides superior surgical resection. Surg Endosc. https://doi.org/10.1007/s00464-020-08120-3 (Epub ahead of print)

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kingma BF, Grimminger PP, van der Sluis PC, van Der MJ, Kouwenhoven EA, Chao YK, Tsai CY, Fuchs HF, Bruns CJ, Sarkaria IS, Luketich JD, Haveman JW, van Etten B, Chiu PW, Chan SM, Rouanet P, Mourregot A, Hölzen JP, Sallum RA, Cecconello I, Egberts JH, Benedix F, van Berge Henegouwen MI, Gisbertz SS, Perez D, Jansen K, Hubka M, Low DE, Biebl M, Pratschke J, Turner P, Pursnani K, Chaudry A, Smith M, Mazza E, Strignano P, Ruurda JP, van Hillegersberg R, UGIRA Study Group (2020) Worldwide techniques and outcomes in Robot-assisted minimally invasive esophagectomy (RAMIE): results from the multicenter international registry. Ann Surg. https://doi.org/10.1097/SLA.0000000000004550 (Epub ahead of print)

    Article  PubMed  Google Scholar 

  6. Okusanya OT, Sarkaria IS, Hess NR, Nason KS, Sanchez MV, Levy RM, Pennathur A, Luketich JD (2017) Robotic assisted minimally invasive esophagectomy (RAMIE): the University of Pittsburgh Medical Center initial experience. Ann Cardiothorac Surg 6(2):179–185

    Article  PubMed  PubMed Central  Google Scholar 

  7. Guerra F, Vegni A, Gia E, Amore Bonapasta S, Di Marino M, Annecchiarico M, Coratti A (2018) Early experience with totally robotic esophagectomy for malignancy. Surgical and oncological outcomes. Int J Med Robot 14(3):e1902

    Article  PubMed  Google Scholar 

  8. Gottlieb-Vedi E, Kauppila JH, Malietzis G, Nilsson M, Markar SR, Lagergren J (2019) Long-term survival in esophageal cancer after minimally invasive compared to open esophagectomy: a systematic review and meta-analysis. Ann Surg 270(6):1005–1017

    Article  PubMed  Google Scholar 

  9. Fransen LFC, Berkelmans GHK, Asti E, van Berge Henegouwen MI, Berlth F, Bonavina L, Brown A, Bruns C, van Daele E, Gisbertz SS, Grimminger PP, Gutschow CA, Hannink G, Hölscher AH, Kauppi J, Lagarde SM, Mercer S, Moons J, Nafteux P, Nilsson M, Palazzo F, Pattyn P, Raptis DA, Räsanen J, Rosato EL, Rouvelas I, Schmidt HM, Schneider PM, Schröder W, van der Sluis PC, Wijnhoven BPL, Nieuwenhuijzen GAP, Luyer MDP, EsoBenchmark Collaborative (2020) The effect of postoperative complications after minimally invasive esophagectomy on long-term survival: an international multicenter cohort study. Ann Surg. https://doi.org/10.1097/SLA.0000000000003772 (Epub ahead of print)

    Article  PubMed  Google Scholar 

  10. Giulianotti PC, Coratti A, Angelini M et al (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138(7):777–784

    Article  PubMed  Google Scholar 

  11. Harbison GJ, Vossler JD, Yim NH, Murayama KM (2019) Outcomes of robotic versus non-robotic minimally-invasive esophagectomy for esophageal cancer: an American College of Surgeons NSQIP database analysis. Am J Surg 218:1223–1228

    Article  PubMed  Google Scholar 

  12. Pesi B, Moraldi L, Guerra F, Tofani F, Nerini A, Annecchiarico M, Coratti A (2019) Surgical and oncological outcomes after ultrasound-guided robotic liver resections for malignant tumor. Analysis of a prospective database. Int J Med Robot 15:e2002

    Article  PubMed  Google Scholar 

  13. Guerra F, Checcacci P, Vegni A, di Marino M, Annecchiarico M, Farsi M, Coratti A (2019) Surgical and oncological outcomes of our first 59 cases of robotic pancreaticoduodenectomy. J Visc Surg 156:185–190

    Article  CAS  PubMed  Google Scholar 

  14. Bongiolatti S, Annecchiarico M, Di Marino M, Boffi B, Borgianni S, Gonfiotti A, Voltolini L, Coratti A (2016) Robot-sewn Ivor-Lewis anastomosis: preliminary experience and technical details. Int J Med Robot 12(3):421–426

    Article  PubMed  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gergen AK, Halpern AL, Helmkamp L, Torphy RJ, White AM, Mitchell JD, Meguid RA, Scott CD, Gleisner AL, McCarter MD, Weyant MJ (2020) Outcomes after converted minimally invasive to open esophagectomy in patients with esophageal cancer. Ann Thorac Surg. https://doi.org/10.1016/j.athoracsur.2020.11.025

    Article  PubMed  PubMed Central  Google Scholar 

  17. van der Sluis PC, van der Horst S, May AM, Schippers C, Brosens LAA, Joore HCA, Kroese CC, Haj Mohammad N, Mook S, Vleggaar FP, Borel Rinkes IHM, Ruurda JP, van Hillegersberg R (2019) Robot-assisted minimally invasive thoracolaparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer: a randomized controlled trial. Ann Surg 269:621–630

    Article  PubMed  Google Scholar 

  18. Markar SR, Ni M, Gisbertz SS, van der Werf L, Straatman J, van der Peet D, Cuesta MA, Hanna GB, van Berge Henegouwen MI, Dutch Upper GI Cancer Audit and TIME Study Group (2020) Implementation of minimally invasive esophagectomy from a randomized controlled trial setting to national practice. J Clin Oncol 38:2130–2139

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kuppusamy MK, Low DE, International Esodata Study Group (IESG) (2020) Evaluation of international contemporary operative outcomes and management trends associated with esophagectomy: a 4-year study of >6000 patients using ECCG definitions and the online esodata database. Ann Surg. https://doi.org/10.1097/SLA.0000000000004309 (Epub ahead of print)

    Article  Google Scholar 

  20. Halpern AL, Friedman C, Torphy RJ, Al-Musawi MH, Mitchell JD, Scott CD, Meguid RA, McCarter MD, Weyant MJ, Gleisner AL (2020) Conversion to open surgery during minimally invasive esophagectomy portends worse short-term outcomes: an analysis of the National Cancer Database. Surg Endosc 34:3470–3478

    Article  PubMed  Google Scholar 

  21. Kalff MC, Fransen LFC, de Groot EM, Gisbertz SS, Nieuwenhuijzen GAP, Ruurda JP, Verhoeven RHA, Luyer MDP, van Hillegersberg R, van Berge Henegouwen MI, Dutch Upper Gastrointestinal Cancer Audit group (2020) Long-term survival after minimally invasive versus open esophagectomy for esophageal cancer: a nationwide propensity-score matched analysis. Ann Surg. https://doi.org/10.1097/SLA.0000000000004708 (Publish Ahead of Print. Epub ahead of print)

    Article  PubMed  Google Scholar 

  22. Visser E, Markar SR, Ruurda JP, Hanna GB, van Hillegersberg R (2019) Prognostic value of lymph node yield on overall survival in esophageal cancer patients: a systematic review and meta-analysis. Ann Surg 269(2):261–268

    Article  PubMed  Google Scholar 

  23. Phillips AW, Lagarde SM, Navidi M, Disep B, Griffin SM (2017) Impact of extent of lymphadenectomy on survival, post neoadjuvant chemotherapy and transthoracic esophagectomy. Ann Surg 265(4):750–756

    Article  PubMed  Google Scholar 

  24. Mariette C, Markar SR, Dabakuyo-Yonli TS, Meunier B, Pezet D, Collet D, D’Journo XB, Brigand C, Perniceni T, Carrère N, Mabrut JY, Msika S, Peschaud F, Prudhomme M, Bonnetain F, Piessen G, Fédération de Recherche en Chirurgie (FRENCH) and French Eso-Gastric Tumors (FREGAT) Working Group (2019) Hybrid minimally invasive esophagectomy for esophageal cancer. N Engl J Med 380(2):152–162

    Article  PubMed  Google Scholar 

  25. Luketich JD, Pennathur A, Awais O, Levy RM, Keeley S, Shende M, Christie NA, Weksler B, Landreneau RJ, Abbas G, Schuchert MJ (2012) Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg 256(1):95

    Article  PubMed  Google Scholar 

  26. de Groot EM, van der Horst S, Kingma BF, Goense L, van der Sluis PC, Ruurda JP, van Hillegersberg R (2020) Robot-assisted minimally invasive thoracolaparoscopic esophagectomy versus open esophagectomy: long-term follow-up of a randomized clinical trial. Dis Esophagus 33(Supplement_2):doaa79

    Google Scholar 

  27. Straatman J, van der Wielen N, Cuesta MA, Daams F, Roig Garcia J, Bonavina L, Rosman C, van Berge Henegouwen MI, Gisbertz SS, van der Peet DL (2017) Minimally invasive versus open esophageal resection: three-year follow-up of the previously reported randomized controlled trial: the TIME trial. Ann Surg 266(2):232–236

    Article  PubMed  Google Scholar 

Download references

Funding

No grant or other sources of funding have been received for the drawing up of this manuscript, which is not submitted or under consideration elsewhere.

Author information

Author notes

  1. Francesco Guerra and Elena Gia share first-authorship.

Authors and Affiliations

  1. Ospedali Riuniti Marche Nord, Pesaro, Italy

    Francesco Guerra

  2. USL Toscana Sud Est, Grosseto, Italy

    Francesco Guerra & Andrea Coratti

  3. Le Scotte University Hospital, Siena, Italy

    Elena Gia

  4. Careggi University Hospital, Firenze, Italy

    Alessio Minuzzo, Angela Tribuzi, Michele Di Marino & Andrea Coratti

Authors
  1. Francesco Guerra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elena Gia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessio Minuzzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Angela Tribuzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michele Di Marino
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrea Coratti
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: EG, AM, AC, and AT. Acquisition of data: EG, AM, MDM, and AT. Analysis and interpretation of data: FG, EG, and AM. Drafting of manuscript: FG, AM, and EG. Critical revision of manuscript: all authors. Approval of the final version of manuscript: all authors.

Corresponding author

Correspondence to Francesco Guerra.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest pertaining to the present manuscript.

Ethics approval

All procedures were in accordance with the ethical standards of the institutional and national research committee and with the Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

A procedure-specifc informed consent has been obtained from each patient.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guerra, F., Gia, E., Minuzzo, A. et al. Robotic esophagectomy: results from a tertiary care Italian center. Updates Surg 73, 839–845 (2021). https://doi.org/10.1007/s13304-021-01050-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-021-01050-2

Keywords

Search

Navigation