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Robot-assisted versus video-assisted thoraco-laparoscopic McKeown’s esophagectomy for esophageal cancer: a propensity score-matched analysis of minimally invasive approaches

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Abstract

Minimally invasive esophagectomy for esophageal cancer decreases overall complication rate and leads to faster postoperative recovery. Robot-assisted minimally invasive esophagectomy is becoming more common. Its three-dimensional view and wristed instruments may provide advantages over traditional thoraco-laparoscopic techniques. There are limited studies comparing robotic and conventional thoraco-laparoscopic esophagectomy. This study aimed to evaluate short-term outcomes of robot-assisted McKeown esophagectomy (RAME) and video-assisted McKeown esophagectomy (VAME). All consecutive patients undergoing minimally invasive McKeown esophagectomy for middle and distal third esophageal cancer between January 2016 and December 2018 at our center were included in this study. Data on baseline characteristics, pathological data and short-term outcomes were collected in a dedicated database. Postoperative complications were defined as per recommendations of Esophagectomy Complications Consensus Group. Histopathologic assessment was performed as per College of American Pathologists guidelines. Propensity score matching was performed for comparison between RAME and VAME groups using age, gender, performance status, American Society of Anesthesiologists grade, body mass index, Charlson Index, tumor location, clinical tumor stage, and neoadjuvant treatment as covariates. A total of 74 patients were included, 25 of whom underwent RAME and 49 underwent VAME. Propensity score matching on 1:1 basis produced 25 pairs of patients, comparable in terms of baseline characteristics. Total operative time and estimated blood loss was similar between the two groups. Length of hospital stay was significantly lower in RAME group. Major postoperative complications (Clavien–Dindo grade ≥ 3A) were more common in VAME group, but not statistically significant. Median number of harvested lymph nodes and R0 resection rate did not differ in between the two groups. In our experience, robot-assisted McKeown esophagectomy was comparable to video-assisted McKeown esophagectomy in terms of safety, feasibility and oncologic adequacy. Use of the robot was associated with reduced hospital stay. Further randomized controlled studies with larger patient samples are needed to compare the two.

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Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Surgical Gastroenterology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad, Pune, Maharashtra, India

    Aditya Kulkarni

  2. Department of Surgical Gastroenterology, Mazumdar Shaw Medical Center, Narayana Health City, Bangalore, India

    Jayant Gul Mulchandani, Mohammed Shies Sadat, Nikhitha Shetty, Sanjeev Shetty & Ashwinikumar Kudari

  3. Department of Pharmacology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India

    M. Praveen Kumar

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  1. Aditya Kulkarni
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  2. Jayant Gul Mulchandani
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  3. Mohammed Shies Sadat
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  4. Nikhitha Shetty
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  5. Sanjeev Shetty
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  7. Ashwinikumar Kudari
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Correspondence to Ashwinikumar Kudari.

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Conflict of interest

Drs. Ashwinikumar Kudari, Aditya Kulkarni, Jayant Gul Mulchandani, Mohammed Shies Sadat, Nikhitha Shetty, Sanjeev Shetty, and Praveen Kumar-M have no conflicts of interest or financial ties to disclose.

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Informed consent was obtained from all individual participants included in the study.

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The study was approved by the institutional research ethics committee.

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This paper has been accepted for quickshot poster presentation at the 2020 SAGES Annual Meeting, Cleveland, Ohio.

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Kulkarni, A., Mulchandani, J.G., Sadat, M.S. et al. Robot-assisted versus video-assisted thoraco-laparoscopic McKeown’s esophagectomy for esophageal cancer: a propensity score-matched analysis of minimally invasive approaches. J Robotic Surg 16, 1289–1297 (2022). https://doi.org/10.1007/s11701-022-01367-z

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  • DOI: https://doi.org/10.1007/s11701-022-01367-z

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