#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Robotic-assisted minimally invasive esophagectomy − our first experience


Authors: T. Haruštiak;  S. Jaroščiaková;  M. Šnajdauf;  A. Pazdro;  R. Lischke
Published in: Rozhl. Chir., 2023, roč. 102, č. 11, s. 422-429.
Category: Review
doi: https://doi.org/10.33699/PIS.2023.102.11.422–429

Overview

Introduction: Minimally invasive esophagectomy is associated with lower postoperative morbidity and better quality of life compared to open esophagectomy in patients with comparable oncological outcomes. Robotic-assisted surgery represents the next step in the development of mini- mally invasive surgery. We aim to present the results of a pilot cohort of patients undergoing robotic-assisted minimally invasive esophagectomy (RAMIE).

Methods: An initial cohort of patients with RAMIE was retrospectively analyzed. Operative characteristics, histopathological results, postoperative course, incidence of complications, and postoperative mortality were evaluated.

Results: From 3/2022 to 6/2023, a total of 31 patients underwent RAMIE at our institution, including hybrid RAMIE (robotic abdomen, open chest) in 11 and total RAMIE in 20 patients. Most patients were male, had locally advanced tumors, predominantly adenocarcinoma and neoadjuvant treat- ment. Thirty patients had Ivor-Lewis and one patient had McKeown esophagectomy. The median total operative time was 495 minutes and median blood loss was 200 mL. R0 resection was achieved in 87% of patients. A median of 26 lymph nodes were removed. Postoperative Clavien-Dindo ≥3 complications occurred in 9 (29%) patients. Four (13%) patients required reoperation. Anastomotic leak was found in 5 (16%) and pneumonia in 9 (29%) patients. The median hospital stay was 9 days. One patient died in the postoperative period. Thirty-day and 90-day mortality rates were 0% and 3.2%, respectively.

Conclusion: Our initial experience shows that RAMIE is a safe surgical procedure and we consider its implementation at our institution to be success- ful. After overcoming the learning curve, we hope to reduce the operative time and increase the medical benefit for the patient.

Keywords:

minimally invasive esophagectomy – robotic-assisted minimally invasive esophagectomy – RAMIE – MIE – carcinoma of the esophagus and gastroesophageal junction


Sources
  1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021 May;71(3):209−249. doi:10.3322/caac.21660.
  2. Demarest CT, Chang AC. The landmark series: Multimodal therapy for esophageal cancer. Ann Surg Oncol. 2021 Jun;28(6):3375−3382. doi:10.1245/s10434020-09565-5.
  3. Schmidt HM, Gisbertz SS, Moons J, et al. Defining benchmarks for transthoracic esophagectomy: A multicenter analysis of total minimally invasive esophagectomy in low risk patients. Ann Surg. 2017 Nov;266(5):814−821. doi:10.1097/ SLA.0000000000002445.
  4. van der Sluis PC, van der Horst S, May AM, et al. Robot-assisted minimally invasive thoracolaparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer: A randomized controlled trial. Ann Surg. 2019 Apr;269(4):621–630. doi:10.1097/ SLA.0000000000003031.
  5. Low DE, Alderson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg. 2015 Aug;262(2):286−294. doi:10.1097/SLA. 0000000000001098.
  6. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205−213. doi:10.1097/01.sla.0000133083.54934.ae.
  7. Kuppusamy MK, Low DE; International Esodata Study Group (IESG). 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. 2022 Mar 1;275(3):515−525. doi:10.1097/SLA.0000000000004309.
  8. de Groot EM, Goense L, Kingma BF, et al. Trends in surgical techniques for the treatment of esophageal and gastroesophageal junction cancer: the 2022 update. Dis Esophagus 2023 Jul 3;36(7):doac099. doi:10.1093/dote/doac099.
  9. Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 2012 May 19;379(9829):1887−1892. doi: 10.1016/S0140-6736(12)60516-9.
  10. Mariette C, Markar SR, Dabakuyo-Yonli TS, et al. Hybrid minimally invasive esophagectomy for esophageal cancer. N Engl J Med. 2019;380(2):152−162. doi:10.1056/NEJMoa180510.
  11. van Workum F, Klarenbeek BR, Baranov N, et al. Totally minimally invasive esophagectomy versus hybrid minimally invasive esophagectomy: systematic review and meta-analysis. Dis Esophagus. 2020;33(8):doaa021. doi:10.1093/dote/ doaa021.
  12. van der Wilk BJ, Hagens ERC, Eyck BM, et al. Outcomes after totally minimally invasive versus hybrid and open Ivor Lewis oesophagectomy: results from the International Esodata Study Group. Br J Surg. 2022;109(3):283−290. doi:10.1093/bjs/znab432.
  13. Markar SR, Ni M, Gisbertz SS, et al. Implementation of minimally invasive esophagectomy from a randomized controlled trial setting to national practice. J Clin Oncol. 2020;38(19):2130−2139. doi:10.1200/JCO.19.02483.
  14. Kernstine KH, DeArmond DT, Karimi M, et al. The robotic, 2-stage, 3-field esophagolymphadenectomy [published correction appears in J Thorac Cardiovasc Surg. 2007 Oct;134(4):959. Campos, Javier C [corrected to Campos, Javier H]]. J Thorac Cardiovasc Surg. 2004;127(6):1847−1849. doi:10.1016/j.jtcvs.2004.02.014.
  15. van Hillegersberg R, Boone J, Draaisma WA, et al. First experience with robot-assisted thoracoscopic esophagolymphadenectomy for esophageal cancer. Surg Endosc. 2006;20(9):1435−1439. doi: 10.1007/s00464-005-0674-8.
  16. Li B, Yang Y, Toker A, et al. International consensus statement on robot-assisted minimally invasive esophagectomy (RAMIE). J Thorac Dis. 2020;12(12):7387−7401. doi:10.21037/jtd-20-1945.
  17. Ekeke CN, Kuiper GM, Luketich JD, et al. Comparison of robotic-assisted minimally invasive esophagectomy versus minimally invasive esophagectomy: A propensity-matched study from a single high-volume institution. J Thorac Cardiovasc Surg. 2023;166(2):374−382.e1. doi:10.1016/j.jtcvs.2022.11.027.
  18. Yang Y, Li B, Yi J, et al. Robot-assisted versus conventional minimally invasive esophagectomy for resectable esophageal squamous cell carcinoma: Early results of a multicenter randomized controlled trial: the RAMIE trial. Ann Surg. 2022;275(4):646–653. doi:10.1097/ SLA.0000000000005023.
  19. Chan KS, Oo AM. Exploring the learning curve in minimally invasive esophagectomy: a systematic review. Dis Esophagus. 2023;36(9):doad008. doi:10.1093/dote/ doad008.
  20. Fuchs HF, Collins JW, Babic B, et al. Robotic-assisted minimally invasive esophagectomy (RAMIE) for esophageal cancer training curriculum-a worldwide Delphi consensus study. Dis Esophagus. 2022;35(6):doab055. doi:10.1093/dote/ doab055.
  21. Jaroščiaková S, Tvrdoň J, Hladík P, et al. Robotic distal pancreatectomy − the first experience. Robotická distální pankreatektomie − první zkušenosti. Rozhl Chir. 2023;102(3):125−129. doi:10.33699/ PIS.2023.102.3.125-129.
  22. Podhráský M, Libánský P, Tvrdoň J. Surgical treatment of hyperparathyroidism with a pathologically changed parathyroid gland found in the mediastinum. Rozhl Chir. 2023;102(4):169−173. doi:10.33699/PIS.2023.102.4.169-173.
  23. Kolařík J, Tavandžis J, Novysedlák R, et al. Robotic pulmonary segmentectomy, initial experience in the Czech Republic. Rozhl Chir. 2023;102(5):199−203. doi:10.33699/PIS.2023.102.5.199-203.
  24. Jíšová B, Skořepa J, Pastor J, et al. Results of robotic colorectal surgery at IIIrd surgical department 1st Faculty of Medicine Charles University. Gastroent Hepatol. 2023;77(2):154−157. doi:10.48095/ccgh2023154.
  25. Harustiak T, Pazdro A, Snajdauf M, et al. Anastomotic leak and stricture after handsewn versus linear-stapled intrathoracic oesophagogastric anastomosis: single-centre analysis of 415 oesophagectomies. Eur J Cardiothorac Surg. 2016;49(6):1650–1659. doi:10.1093/ejcts/ezv395.
  26. Kalff MC, van Berge Henegouwen MI, Gisbertz SS. Textbook outcome for esophageal cancer surgery: an international consensus-based update of a quality measure. Dis Esophagus 2021;34(7):doab011. doi:10.1093/dote/doab011.
  27. Goense L, van der Sluis PC, van der Horst S, et al. Cost analysis of robot-assisted versus open transthoracic esophagectomy for resectable esophageal cancer. Results of the ROBOT randomized clinical trial [published online ahead of print, 2023 Jul 1]. Eur J Surg Oncol. 2023;S0748−7983(23)00562-0. doi:10.1016/ j.ejso.2023.06.020.
Labels
Surgery Orthopaedics Trauma surgery
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#