Initial experience of robot-assisted Ivor–Lewis esophagectomy: 61 consecutive cases from a single Chinese institution

Abstract

This study aims to report the technical details and preliminary outcomes of robot-assisted Ivor-Lewis esophagectomy (RAILE) using two different types of intrathoracic anastomosis from a single institution in China. From May 2015 to October 2017, 61 patients diagnosed with mid-lower esophageal cancer were treated with RAILE. The RAILE procedure was performed in two stages. The first 35 patients underwent circular end-to-end stapled intrathoracic anastomosis (stapled group), and the remaining 26 patients had a double-layered, completely hand-sewn intrathoracic anastomosis (hand-sewn group). Patient characteristics, surgical techniques, postoperative complications, and pathology outcomes were analyzed. The mean operating time and mean blood loss were 315.6 ± 59.4 minutes and 189.3 ± 95.8 mL, respectively. There was one patient who underwent conversion to thoracotomy. The 30-day and in-hospital mortality rates were 0%. Overall complications were observed in 22 patients (36.1%) according to the Clavien-Dindo (CD) and the Esophagectomy Complications Consensus Group (ECCG) classifications, of whom 6 patients (9.8%) had anastomotic leakage (ECCG, Type II). The median length of hospitalization (LOH) was 10 days (IQR, 5 days). Complete (R0) resection was achieved in all cases. The mean tumor size was 3.2 ± 1.5 cm, and the mean number of totally dissected lymph nodes was 19.3 ± 9.2. Regarding the operative outcomes between stapled and hand-sewn groups, there were no significant differences in the operative time (325.4 ± 66.6 vs. 302.3 ± 45.9 min, P = 0.114), blood loss (172.9 ± 74.1 vs. 211.5 ± 117.0 mL, P = 0.147), conversion rate (2.9 vs. 0%, P = 1.000), overall complication rate (37.1 vs. 34.6%, P = 0.839) or LOH (10 vs. 9.5 days, P = 0.415). RAILE using both stapled and hand-sewn intrathoracic anastomosis is safe and technically feasible with satisfactory perioperative outcomes for the treatment of mid-lower thoracic esophageal cancer.

Pretreatment-assisted robot intrathoracic layered anastomosis: our exploration in Ivor-Lewis esophagectomy

“…There were also several reports on robot hand-sewn intrathoracic EGA. But they only contained a small number of surgical cases and the technique of robot hand-sewn intrathoracic EGA was still under exploration without wide acceptation (14)(15)(16)(17)(18)(19).…”

Robot‐assisted minimally invasive esophagectomy for esophageal cancer: Meticulous surgery minimizing postoperative complications

“…[28][29][30] Table 2 shows case series studies of Ivor Lewis RAMIE including more than 10 cases. [31][32][33][34][35][36][37][38][39][40][41][42] Only four studies reported recurrent nerve injury with the average rate of 4.2%. 31,33,37,39 On the other hand, recurrent nerve injury rates in the case series of McKeown RAMIE were reported to be 2.9%-29% with the average rate of 15.9%.…”

Robotic esophagectomy: the evolution of open esophagectomy to current techniques and a review of the literature

“…Morbidity was minimal, 30-day mortality was 0%, and they ultimately concluded that RAILE was a safe and oncologically sound procedure [62] . Since that time, many more have reported on their experience performing robotic IL esophagectomy [74][75][76][77][78][79][80][81] and more recently, Nora et al [82] reviewed outcomes of RAILE. When completed by an experienced surgeon, RAILE has comparable times to esophagectomies performed via minimally invasive approaches [28,83] .…”