Abstract
We aim to review the available literature on patients with esophageal cancer treated with robot-assisted (RAME) or video-assisted McKeown’s esophagectomy (VAME), to compare the efficacy and safety of the two approaches. Original research studies that evaluated perioperative and oncologic outcomes of RAME versus VAME were identified, from January 1990 to July 2022. The 90-day mortality, the R0 resection rate, the dissected lymph nodes, the perioperative parameters, and the complications were calculated according to a fixed and a random effect model. The Q statistics and I2 statistic were used to test for heterogeneity among the studies. Seven studies were included, incorporating a total of 1617 patients treated with RAME or VAME. The 90-day mortality was similar between the two groups. No difference was found regarding the R0 resection rate and the number of dissected lymph nodes. In addition, the perioperative parameters, along with the total complications were similar between RAME and VAME. Nonetheless, the incidence of postoperative pneumonia was higher in the VAME group (OR:0.67 [95% CI: 0.49, 0.93]; p = 0.02). Finally, our outcomes were further validated by sensitivity analysis including only studies performing propensity score-matched analysis. Our meta-analysis showed that RAME was equivalent to VAME in terms of safety, feasibility, and oncologic adequacy. These results should be interpreted with caution due to the small number of included studies. New Randomized Controlled trials, that are currently active, will provide further evidence with greater clarity to assess the effectiveness and safety of RAME for esophageal cancer.
Similar content being viewed by others
References
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J (2012) Jemal A (2015) Global cancer statistics. CA Cancer J Clin 65(2):87–108
Samarasam I (2017) Esophageal cancer in India: current status and future perspectives. Int J Adv Med Health Res 4(1):5–10
Sakamoto T, Fujiogi M, Matsui H, Fushimi K, Yasunaga H (2021) Comparing perioperative mortality and morbidity of minimally invasive esophagectomy versus open esophagectomy for esophageal cancer: a nationwide retrospective analysis. Ann Surg 274(2):324–330
Wang K, Zhong J, Liu Q, Lin P, Fu J (2022) A Propensity score-matched analysis of thoracolaparoscopic vs open mckeown’s esophagectomy. Ann Thorac Surg 113(2):473–481. https://doi.org/10.1016/j.athoracsur.2021.02.012 (Epub 2021 Feb 20)
Straatman J, van der Wielen N, Cuesta MA, Daams F, Roig Garcia J, Bonavina L et al (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
Guo W, Ma X, Yang S, Zhu X, Qin W, Xiang J et al (2016) Combined thoracoscopic-laparoscopic esophagectomy versus open esophagectomy: a meta-analysis of outcomes. Surg Endosc 30(9):3873–3881
Bonavina L, Asti E, Sironi A, Bernardi D, Aiolfi A (2017) Hybrid and total minimally invasive esophagectomy: how I do it. J Thorac Dis 9(Suppl 8):S761–S772. https://doi.org/10.21037/jtd.2017.06.55.PMID:28815072;PMCID:PMC5538984
Bonavina L, Scolari F, Aiolfi A, Bonitta G, Sironi A, Saino G, Asti E (2016) Early outcome of thoracoscopic and hybrid esophagectomy: propensity-matched comparative analysis. Surgery 159(4):1073–1081. https://doi.org/10.1016/j.surg.2015.08.019 (Epub 2015 Sep 28 PMID: 26422764)
Angeramo CA, Bras Harriott C, Casas MA, Schlottmann F (2021) Minimally invasive Ivor Lewis esophagectomy: Robot-assisted versus laparoscopic-thoracoscopic technique. System rev meta-analysis Surg 170(6):1692–1701. https://doi.org/10.1016/j.surg.2021.07.013 (Epub 2021 Aug 11)
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 62:1
Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. 2011 www.cochrane-handbook.org
Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605
Sterne JA, Hernan MA, Reeves BC et al (2016) ROBINS-I: A tool for assessing risk of bias in non-randomized studies of interventions. BMJ 355:4919
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634
Chao YK, Hsieh MJ, Liu YH, Liu HP (2018) Lymph node evaluation in robot-assisted versus video-assisted thoracoscopic esophagectomy for esophageal squamous cell carcinoma: a propensity-matched analysis. World J Surg 42(2):590–598. https://doi.org/10.1007/s00268-017-4179-0 (PMID: 28801820)
Duan X, Yue J, Chen C, Gong L, Ma Z, Shang X, Yu Z, Jiang H (2021) Lymph node dissection around left recurrent laryngeal nerve: robot-assisted vs. video-assisted McKeown esophagectomy for esophageal squamous cell carcinoma. Surg Endosc 35(11):6108–6116. https://doi.org/10.1007/s00464-020-08105-2 (Epub 2020 Oct 26 PMID: 33104915; PMCID: PMC7586865)
Kulkarni A, Mulchandani JG, Sadat MS, Shetty N, Shetty S, Kumar MP, Kudari A (2022) Robot-assisted versus video-assisted thoraco-laparoscopic McKeown’s esophagectomy for esophageal cancer: a propensity score-matched analysis of minimally invasive approaches. J Robot Surg. https://doi.org/10.1007/s11701-022-01367-z (Epub ahead of print. PMID: 35044671)
Oshikiri T, Goto H, Horikawa M, Urakawa N, Hasegawa H, Kanaji S, Yamashita K, Matsuda T, Nakamura T, Kakeji Y (2021) Incidence of recurrent laryngeal nerve palsy in robot-assisted versus conventional minimally invasive mckeown esophagectomy in prone position: a propensity score-matched study. Ann Surg Oncol 28(12):7249–7257. https://doi.org/10.1245/s10434-021-10123-w (Epub 2021 May 25 PMID: 34032960)
Trung LV, Loc NVV, Tien TPD, Ai BD, Lam TLQ, Vuong NL (2021) Robot-assisted versus thoraco-laparoscopic mckeown esophagectomy for esophageal cancer: a propensity score-matched study. J Gastrointest Surg. https://doi.org/10.1007/s11605-021-05200-0 (Epub ahead of print PMID: 34786664)
Xu Y, Li XK, Cong ZZ, Zhou H, Wu WJ, Qiang Y, Yi J, Shen Y (2021) Long-term outcomes of robotic-assisted versus thoraco-laparoscopic McKeown esophagectomy for esophageal cancer: a propensity score-matched study. Dis Esophagus 34(9):114. https://doi.org/10.1093/dote/doaa114 (PMID: 33150401)
Yang Y, Zhang X, Li B, Hua R, Yang Y, He Y, Ye B, Guo X, Sun Y, Li Z (2020) Short- and mid-term outcomes of robotic versus thoraco-laparoscopic McKeown esophagectomy for squamous cell esophageal cancer: a propensity score-matched study. Dis Esophagus 33(6):80. https://doi.org/10.1093/dote/doz080 (PMID: 31608939)
Napier KJ, Scheerer M, Misra S (2014) Esophageal cancer: a review of epidemiology, pathogenesis, staging workup and treatment modalities. World J Gastrointest Oncol. 6(5):112–120
Then EO, Lopez M, Saleem S et al (2020) Esophageal cancer: an updated surveillance epidemiology and end results database analysis. World J Oncol 11(2):55–64. https://doi.org/10.14740/wjon1254
Kernstine KH, DeArmond DT, Karimi M, Van Natta TL, Campos JH, Yoder MR et al (2004) The robotic, 2-stage, 3-field esophagolymphadenectomy. J Thorac Cardiovasc Surg 127(6):1847–1849
Mederos MA, de Virgilio MJ, Shenoy R et al (2021) Comparison of clinical outcomes of robot-assisted, video-assisted, and open esophagectomy for esophageal cancer: a systematic review and meta-analysis. JAMA Netw Open 4(11):e2129228. https://doi.org/10.1001/jamanetworkopen.2021.29228 (PMID: 34724556)
Udagawa H, Ueno M, Shinohara H, Haruta S, Kaida S, Nakagawa M et al (2012) The importance of grouping of lymph node stations and rationale of three-field lymphoadenectomy for thoracic esophageal cancer. J Surg Oncol 106(6):742–747
Yang Y, Zhang X, Li B, Li Z, Sun Y, Mao T et al (2019) Robotassisted esophagectomy (RAE) versus conventional minimally invasive esophagectomy (MIE) for resectable esophageal squamous cell carcinoma: protocol for a multicenter prospective randomized controlled trial (RAMIE trial, robot-assisted minimally invasive esophagectomy). BMC Cancer 19(1):608
Chao Y-K, Li Z-G, Wen Y-W, Kim D-J, Park S-Y, Chang Y-L et al (2019) Robotic-assisted esophagectomy vs video-assisted thoracoscopic esophagectomy (REVATE): study protocol for a randomized controlled trial. Trials 20(1):346
Acknowledgements
The participating authors declare no sources of financial report that require acknowledgement.
Author information
Authors and Affiliations
Contributions
DEM contributed to conception/design of the work, the acquisition, analysis, and interpretation of data, drafting, revising, and final approval of the manuscript. PAZ contributed to the design, acquisition, analysis, and interpretation of data, revising, and final approval of the manuscript. MPF and DK contributed to the acquisition/analysis of data, drafting, revising, and final approval of the manuscript. DZ and AD contributed to the design, the acquisition/analysis of data, drafting, revising, and final approval of the manuscript. KS contributed to the analysis of data, revising, and final approval of the manuscript. TA contributed to the conception/design of the work, the interpretation of data, drafting, revising, and final approval of the manuscript.
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare no conflicts of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed Consent
Does not apply.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Magouliotis, D.E., Zotos, PA., Fergadi, M.P. et al. Meta-analysis of robot-assisted versus video-assisted McKeown esophagectomy for esophageal cancer. Updates Surg 74, 1501–1510 (2022). https://doi.org/10.1007/s13304-022-01343-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13304-022-01343-0