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Assessment of Quality Outcomes and Learning Curve for Robot-Assisted Minimally Invasive McKeown Esophagectomy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to identify the results of the quality assessment and the learning curve of robot-assisted minimally invasive McKeown esophagectomy (RAMIE-MK).

Methods

The study retrospectively reviewed the data of 400 consecutive patients with esophageal cancer who underwent RAMIE-MK by a single surgeon from November 2015 to March 2019. Cumulative summation analysis of the learning curve was performed. The patients were divided into decile cohorts of 40 cases to minimize demographic deviations and to maximize the power of detecting statistically significant changes in performance.

Results

The 90-day mortality rate for all the patients was 0.5% (2 cases). The authors’ experience was divided into the ascending phase (40 cases), the plateau phase (175 cases), and the descending phase (185 cases). After 40 cases, significant improvements in operative time (328 vs. 251 min; P = 0.019), estimated blood loss (350 vs. 200 ml; P = 0.031), and conversion rates (12.5% vs. 2.5%; P < 0.001) were observed. After 80 cases, a decrease in the rates of anastomotic leakage (22.5% vs. 8.1%; P = 0.001) and vocal cord palsy (31.3% vs. 18.4%; P = 0.024) was observed. The number of harvested lymph nodes increased after 40 cases (13 vs. 23; P < 0.001), especially for lymph nodes along the recurrent laryngeal nerve (3.0 vs. 6.0; P < 0.001).

Conclusions

The learning phase of RAMIE-MK consists of 40 cases, and quality outcomes can be improved after 80 procedures. Several turning points related to the optimization of surgical outcomes can be used as benchmarks for surgeons performing RAMIE-MK.

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Acknowledgment

This work was supported by Three Years of Clinical Innovation Action Plan of Shanghai Hospital Development Center (16CR1035B). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

Author information

Author notes

  1. Yang Yang and Bin Li have contributed equally to this work.

Authors and Affiliations

  1. Division of Esophageal Surgery, Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China

    Yang Yang MD, Bin Li MD, Rong Hua MD, Xiaobin Zhang MD, Haoyao Jiang MD, Yifeng Sun MD & ZhiGang Li MD

  2. Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy

    Giulia Veronesi MD

  3. IRCCS San Raffaele Scientific Institute, Milan, Italy

    Giulia Veronesi MD

  4. Unit of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy

    Sara Ricciardi MD

  5. European Institute of Oncology IRCCS, Milan, Italy

    Monica Casiraghi MD, IEO

  6. Department of Thoracic Surgery, Hôpital Privé D’Antony, Ramsay Générale de Santé, Antony, France

    Marion Durand MD, PhD

  7. Division of Thoracic Surgery, Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA

    Raul Caso MD

  8. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Inderpal S. Sarkaria MD, FACS

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  1. Yang Yang MD
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Written on behalf of the AME Thoracic Surgery Collaborative Group

Corresponding author

Correspondence to ZhiGang Li MD.

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Disclosure

Dr. Giulia Veronesi has financial relationships with AB Medica SpA and Medtronic Italia SpA. Dr. Marion Durand is an official proctor for Intuitive Surgical. However, these authors have no conflict of interest regarding this research. The remaining authors have no conflicts of interest.

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Yang, Y., Li, B., Hua, R. et al. Assessment of Quality Outcomes and Learning Curve for Robot-Assisted Minimally Invasive McKeown Esophagectomy. Ann Surg Oncol 28, 676–684 (2021). https://doi.org/10.1245/s10434-020-08857-0

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  • DOI: https://doi.org/10.1245/s10434-020-08857-0

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