Early experience with totally robotic esophagectomy for malignancy. Surgical and oncological outcomes

Guerra, Francesco; Vegni, Alessandra; Gia, Elena; Bonapasta, Stefano Amore; Marino, Michele; Annecchiarico, Mario; Coratti, Andrea

doi:10.1002/rcs.1902

Cited by 14 publications

(15 citation statements)

References 34 publications

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“…This issue could be reduced with the use of NRF (Near InfraRed Fluorescence) associated with the intravenous administration of indocyanine green. With NRF, the surgeon could obtain a real-time gastric conduit perfusion, identifying inadequately perfused or ischemic areas and then the surgeon could construct the esophagogastric anastomosis on a well-perfused conduit [30,41] . Moreover, the latest robotic platform is armed with robotic staplers and the surgeon can create a mechanical end-to-side esophagogastric anastomosis with easier handling.…”

Section: Discussionmentioning

confidence: 99%

“…Handsewn anastomosis can be performed with the robotic platform, but it did not show clear advantages in terms of reduced incidence of anastomotic leak or stricture, and is associated with longer operative times [20] . The last Xi DaVinci® platform is armed with robotic staplers and some surgeons have shifted from handsewn to mechanical anastomosis [30] .…”

Section: Trans-thoracic Ramie With Intrathoracic Anastomosis (Ivor-lewis Procedures -Ile-)mentioning

confidence: 99%

“…Three-field esophagectomy starts with complete mediastinal mobilization, radical thoracic lymphadenectomy and esophageal dissection in the upper region of the chest [31] . As for the Ivor Lewis procedure, the McKeown's thoracic phase could be performed through the left lateral decubitus or prone position [21,27,29,30] . After the thoracic phase, gastrolysis, celiac lymph node dissection and gastric conduit construction can be performed in the abdomen [21,29,30] .…”

Section: Trans-thoracic Ramie With Cervical Anastomosis (Mckeown Procedures -Mke-)mentioning

confidence: 99%

“…As for the Ivor Lewis procedure, the McKeown's thoracic phase could be performed through the left lateral decubitus or prone position [21,27,29,30] . After the thoracic phase, gastrolysis, celiac lymph node dissection and gastric conduit construction can be performed in the abdomen [21,29,30] . The gastric conduit is then pulled-up through the posterior mediastinum and the esophago-gastric anastomosis is performed in the neck [14,21] .…”

Section: Trans-thoracic Ramie With Cervical Anastomosis (Mckeown Procedures -Mke-)mentioning

confidence: 99%

“…Large studies are needed to determine which technique is associated with less anastomotic complications, even if a group reported the shift from hand-sewn end-to-side intrathoracic anastomosis to linear-stapled, reducing the post-operative leak rates [30] .…”

Section: Technical Aspects Of Anastomosismentioning

confidence: 99%

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Robot-assisted minimally invasive esophagectomy: systematic review on surgical and oncological outcomes

Bongiolatti¹,

Farronato²,

Marino³

et al. 2020

Mini-invasive Surg

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Aim: Esophagectomy is associated with several post-operative complications (50%-70%) due to surgical trauma. Minimally invasive techniques have therefore been applied to decrease mortality and morbidity. Robotassisted minimally-invasive esophagectomy (RAMIE) was developed to overcome the drawbacks of the thoracolaparoscopic approach. The objective of this systematic review is to report some recent experiences and to compare RAMIE with other approaches to esophagectomy, focusing on technical and oncological aspects.Methods: Pubmed, Embase and Scopus databases were searched for "robot-assisted esophagectomy", "minimally invasive esophagectomy" and "robotic esophagectomy" in January 2020. The study was focused on original papers on totally endoscopic RAMIE in the English language. No statistical procedures (meta-analysis) were performed.Results: Three hundred and twenty studies were identified across the database and after screening and reviewing, 14 were included for final analysis. The overall 90-day post-operative mortality after trans-thoracic esophagectomy ranged from 0% to 9% and did not differ between approaches. Post-operative complications ranged between 24% and 60.9%: respiratory (6.25% to 65%), cardiac (0.8% to 32%), anastomotic leak (3.1% and 37.5%) and vocal cord palsy (9.1%-35%) were the most frequent. The evidence for long-term outcomes is weak, with no significant differences in overall survival, disease-free survival and recurrence identified in comparison with other approaches. The selected papers showed that RAMIE had comparable outcomes between the open and thoraco-laparoscopic approaches within a multimodal treatment pathway. Conclusion:RAMIE also seems to be associated with better lymph node dissection, nerve sparing and quality of life, but larger studies are needed to obtain more evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Trans-thoracic Ramie With Intrathoracic Anastomosis (Ivor-lewis Procedures -Ile-)mentioning

confidence: 99%

Section: Trans-thoracic Ramie With Cervical Anastomosis (Mckeown Procedures -Mke-)mentioning

confidence: 99%

Section: Trans-thoracic Ramie With Cervical Anastomosis (Mckeown Procedures -Mke-)mentioning

confidence: 99%

Section: Technical Aspects Of Anastomosismentioning

confidence: 99%

See 3 more Smart Citations

Robot-assisted minimally invasive esophagectomy: systematic review on surgical and oncological outcomes

Bongiolatti¹,

Farronato²,

Marino³

et al. 2020

Mini-invasive Surg

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Meta-analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy

Schizas

Kosmopoulos

Giannopoulos

et al. 2019

British Journal of Surgery

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Background: Oesophagectomy is associated with high morbidity and mortality rates. New-onset atrial fibrillation (AF) is a frequent complication following oesophagectomy. Several studies have explored whether new-onset AF is associated with adverse events after oesophagectomy.Methods: This review was performed according to PRISMA guidelines. Eligible studies were identified through a search of PubMed, Scopus and Cochrane CENTRAL databases up to 25 November 2018. A meta-analysis was conducted with the use of random-effects modelling. The I 2 statistic was used to assess for heterogeneity.Results: In total, 53 studies including 9087 patients were eligible for analysis. The overall incidence of postoperative AF was 16⋅5 per cent. Coronary artery disease and hypertension were associated with AF, whereas diabetes, smoking and chronic obstructive pulmonary disease were not. Patients with AF had a significantly higher risk of overall postoperative adverse events than those without fibrillation (odds ratio (OR) 5⋅50, 95 per cent c.i. 3⋅51 to 8⋅30), including 30-day mortality (OR 2⋅49, 1⋅70 to 3⋅64), anastomotic leak (OR 2⋅65, 1⋅53 to 4⋅59) and pneumonia (OR 3⋅42, 2⋅39 to 4⋅90).Conclusion: Postoperative AF is frequently observed in patients undergoing oesophagectomy for cancer. It is associated with an increased risk of death and postoperative complications.

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Fully Robotic Side‐to‐Side Linear‐Stapled Anastomosis During Robotic Ivor Lewis Esophagectomy

Guerra¹,

Tribuzi²,

Giuliani³

et al. 2023

World j. surg.

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Background The adoption of robotic surgery for esophageal cancer has been expanding rapidly over the recent years. In the setting of two-field esophagectomy, different techniques exist for intrathoracic esophagogastric anastomosis, although the superiority of one over another has not been clearly demonstrated. Potential benefits in terms of anastomotic leakage and stenosis have been reported in association with a linear-stapled anastomosis as compared to the more widespread techniques of circular mechanical and hand-sewn reconstructions, however, there is still limited reported evidence on its application to robotic surgery. We here report our fully robotic technique of side-to-side, semi-mechanical anastomosis. Methods All consecutive patients undergoing fully robotic esophagectomy featuring intrathoracic side-to-side stapled anastomosis by a single surgical team were included in this analysis. Operative technique is detailed, and perioperative data are assessed. Results A total of 49 patients were included. There were no intraoperative complications and no conversion occurred. The rate of overall postoperative morbidity was 25, 14% being the relative rate of major complications. With anastomotic-related morbidity in particular, one patient developed minor anastomotic leakage. Conclusions Our experience demonstrates that a linear, side-to-side fully robotic stapled anastomosis can be created with a high technical success and minimal incidence of anastomosis-related morbidity.

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Early experience with totally robotic esophagectomy for malignancy. Surgical and oncological outcomes

Abstract: Robotic surgery can be employed to treat esophageal malignancy competently. Robotic esophagectomy satisfies all features of pathologic appropriateness and offers the expected oncological results.

Cited by 14 publications

References 34 publications

Robot-assisted minimally invasive esophagectomy: systematic review on surgical and oncological outcomes

Robot-assisted minimally invasive esophagectomy: systematic review on surgical and oncological outcomes

Meta-analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy

Fully Robotic Side‐to‐Side Linear‐Stapled Anastomosis During Robotic Ivor Lewis Esophagectomy

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