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Learning Curve of Robot-Assisted Lymph Node Dissection of the Left Recurrent Laryngeal Nerve: A Retrospective Study of 417 Patients

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

Abstract

Objective

Left recurrent laryngeal nerve (no.106recL) lymph node dissection is a challenging procedure, and robotic-assisted minimally invasive esophagectomy (RAMIE) may have some advantages. This study aimed to determine the learning curve of no.106recL lymph node dissection.

Methods

The data of 417 patients who underwent McKeown RAMIE between June 2017 and June 2022 were retrospectively analyzed. The lymph node harvest of no.106recL was used to determine the learning curve, and the cumulative sum (CUSUM) method was employed to obtain the inflection point.

Results

A total of 404 patients (404/417, 96.9%) underwent robotic surgery. Based on the number of no.106recL lymph nodes harvested, the CUSUM learning curve was mapped and divided into three phases: phase I (1‒75 cases), phase II (76‒240 cases), and phase III (241‒404 cases). The median (IQR) number of no.106recL lymph node harvests were 1 (4), 3 (6,) and 4 (4) in each phase (p < 0.001). The lymph node dissection rate gradually increased from 62.7% in phase I to 82.9% in phase III (p = 0.001). The total and thoracic lymph node harvest gradually increased (p < 0.001), whereas operation time (p = 0.001) and blood loss gradually decreased (p < 0.001). Moreover, the incidence of total complication (p = 0.020) and recurrent laryngeal nerve injury (p = 0.001) significantly decreased, and the postoperative hospital stay gradually shortened (p < 0.001).

Conclusion

Robotic no.106recL lymph node dissection has some advantages for patients with esophageal cancer. In this study, perioperative and clinical outcomes were significantly improved over the learning curve. However, further prospective studies are required to confirm our results.

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Acknowledgment

This study was partially funded by the Beijing Xisike Clinical Oncology Research Foundation (Grant Numbers: Y-MSD2020-0346 and Y-MSDZD-2021-0239), Beijing-Tianjin-Hebei Basic Research Project of the Tianjin Science and Technology Bureau (Grant Number: 20JCZXJC00050), Important Specific Projects of Public Health of the Tianjin Science and Technology Bureau (Grant Number: 21ZXGWSY00020), Tianjin Health Science and Technology Talent Cultivation Project (Grant Number: KJ20135), Construction Project of Precision Treatment of Oncology Surgery in the Tianjin Medical University Cancer Hospital (Grant Number: ZLWKJZZL02), and The “14th Five-Year” Peak Discipline Support Program of the Tianjin Medical University Cancer Hospital (Grant Number: 7-2-17).

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Authors and Affiliations

  1. Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Hospital and Institute, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China

    Xiaofeng Duan MD, PhD, Jie Yue MD, Xiaobin Shang MD, PhD, Chuangui Chen MD, PhD, Zhao Ma MD, PhD, Zuoyu Chen MD, PhD, Chen Zhang MD, PhD & Hongjing Jiang MD, PhD

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  1. Xiaofeng Duan MD, PhD
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  2. Jie Yue MD
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  3. Xiaobin Shang MD, PhD
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  4. Chuangui Chen MD, PhD
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  5. Zhao Ma MD, PhD
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  6. Zuoyu Chen MD, PhD
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  7. Chen Zhang MD, PhD
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Correspondence to Xiaofeng Duan MD, PhD or Hongjing Jiang MD, PhD.

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Duan, X., Yue, J., Shang, X. et al. Learning Curve of Robot-Assisted Lymph Node Dissection of the Left Recurrent Laryngeal Nerve: A Retrospective Study of 417 Patients. Ann Surg Oncol 30, 3991–4000 (2023). https://doi.org/10.1245/s10434-023-13430-6

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  • DOI: https://doi.org/10.1245/s10434-023-13430-6

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