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

Yang, Yang; Li, Bin; Hua, Rong; Zhang, Xiaobin; Jiang, Haoyao; Sun, Yifeng; Veronesi, Giulia; Ricciardi, Sara; Casiraghi, Monica; Durand, Marion; Caso, Raul; Sarkaria, Inderpal S.; Li, Zhigang

doi:10.1245/s10434-020-08857-0

Cited by 25 publications

(19 citation statements)

References 24 publications

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“…But this is also the general requirements for a randomized controlled trial study of new technology. We believe that for the beginners, RAMIE's learning curve will be better than conventional MIE 36 . However, this is not within the scope of the RAMIE trial.…”

Section: Discussionmentioning

confidence: 92%

Robot-assisted Versus Conventional Minimally Invasive Esophagectomy for Resectable Esophageal Squamous Cell Carcinoma

Yang

et al. 2021

Annals of Surgery

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105

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Objective:To compare perioperative and long-term outcomes of robot-assisted minimally invasive esophagectomy (RAMIE) and conventional minimally invasive esophagectomy (MIE) in the treatment for patients with esophageal squamous cell carcinoma (ESCC).Summary Background Data:RAMIE has emerged as an alternative to traditional open or thoracoscopic approaches. Efficacy and safety of RAMIE and MIE in the surgical treatment for ESCC remains uncertain given the lack of high-level clinical evidence.Methods:The RAMIE trial was designed as a prospective, multicenter, randomized, controlled clinical trial that compares the efficacy and safety of RAMIE and MIE in the treatment of resectable ESCC. From August 2017 to December 2019, eligible patients were randomly assigned to receive either RAMIE or MIE performed by experienced thoracic surgeons from 6 high-volume centers in China. Intent-to-treat analysis was performed.Results:Significantly shorter operation time was taken in RAMIE (203.8 vs 244.9 min, P<0.001). Compared with MIE, RAMIE showed improved efficiency of thoracic lymph node dissection in patients who received neoadjuvant therapy (15 vs 12, P = 0.016), as well as higher achievement rate of lymph node dissection along the left recurrent laryngeal nerve (79.5% vs 67.6%, P = 0.001). No difference was found in blood loss, conversion rate, and R0 resection. The 90-day mortality was 0.6% in each group. Overall complications were similar in RAMIE (48.6%) compared with MIE (41.8%) (RR, 1.16; 95% CI, 0.92–1.46; P = 0.196). Besides, the rate of major complications (Clavien-Dindo classification ≥ III) was also comparable (12.2% vs 10.2%, P = 0.551). RAMIE showed similar incidences of pulmonary complications (13.8% vs 14.7%; P = 0.812), anastomotic leakage (12.2% vs 11.3%; P = 0.801), and vocal cord paralysis (32.6% vs 27.1%, P = 0.258) to MIE.Conclusions:Early results demonstrate that both RAMIE and MIE are safe and feasible for the treatment of ESCC. RAMIE can achieve shorter operative duration and better lymph node dissection in patients who received neoadjuvant therapy. Long-term results are pending for further follow-up investigations.Trial Registration:ClinicalTrial.gov Identifier: NCT03094351.

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Section: Discussionmentioning

confidence: 92%

Robot-assisted Versus Conventional Minimally Invasive Esophagectomy for Resectable Esophageal Squamous Cell Carcinoma

Yang

et al. 2021

Annals of Surgery

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105

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“…This was thought to be related to the change in anastomosis method to the Totally Mechanical Collard anastomosis. It has been shown in previous articles [30][31][32] that major complications decrease as the number of experienced surgeons increases. The fact that anastomotic leakage has decreased in the late group (2015-2020) at our hospital suggests that the technique and method have become more proficient.…”

Section: Discussionmentioning

confidence: 92%

Operative outcomes and long‐term survival of patients undergoing colon interposition after esophagectomy for cancer

et al. 2022

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Background: The first choice of an esophageal substitute after esophagectomy for cancer is the stomach. However, the colon must be considered for reconstruction in specific situations. The purpose of this study was to clarify the frequency and clinical features of patients who underwent colon interposition in thoracic esophagectomy and to investigate the postoperative complications and survival. Methods: We conducted a retrospective case-control study in the National Cancer Center Hospital East, Japan. Patients who underwent colon interposition after esophagectomy for cancer between 2010 and 2020 were analyzed. Results: Eighty-eight patients underwent esophagectomy with colon interposition; 53.2% received preoperative treatment and 52.3% underwent thoracoscopic surgery. Clavien-Dindo grade >III postoperative complications occurred in 42% of the patients; anastomotic leakage was the most common complication, occurring in 26.1% of the cases. Univariate analysis of the factors associated with Clavien-Dindo grade III complications.

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“…An initial working group identified representative international esophageal surgical centers and individual surgeons. Experts were defined as having performed more than 50 cases of robotic esophagectomy, as we previously demonstrated a significant reduction of operating time after 40 cases (18). A total of 23 international experts were initially identified, of which 21 agreed to participate in the consensus statements, with the following missions:…”

Section: Methodsmentioning

confidence: 99%

“…However, no previous RCT study demonstrated the superiority of RAMIE to traditional thoracoscopy, with the exception of two ongoing studies of REVATE and RAMIE (16,17). Retrospective studies suggest improved lymphadenectomy, decreased intraoperative blood loss, and potentially shorter intensive care unit stays (18).…”

Section: Introductionmentioning

confidence: 99%

International consensus statement on robot-assisted minimally invasive esophagectomy (RAMIE)

Yang

Toker

et al. 2020

J Thorac Dis

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

Cited by 25 publications

References 24 publications

Robot-assisted Versus Conventional Minimally Invasive Esophagectomy for Resectable Esophageal Squamous Cell Carcinoma

Robot-assisted Versus Conventional Minimally Invasive Esophagectomy for Resectable Esophageal Squamous Cell Carcinoma

Operative outcomes and long‐term survival of patients undergoing colon interposition after esophagectomy for cancer

International consensus statement on robot-assisted minimally invasive esophagectomy (RAMIE)

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