McKeown esophagectomy: robot-assisted versus conventional minimally invasive technique—systematic review and meta-analysis

Zhou, Jianghui; Xu, Jinye; Chen, Liangliang; Hu, Junxi; Shu, Yusheng

doi:10.1093/dote/doac011

Cited by 7 publications

(15 citation statements)

References 47 publications

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“…With regard to the comparison of postoperative complications in the two groups, our results indicated that RAMIE has similar outcomes to MIE, but is associated with a lower incidence of pneumonia [9.61% (95% CI: 7.38%–11.84%) vs 14.74% (95% CI: 11.62%–18.15%); OR = 0.73; 95% CI: 0.58-0.93; P =0.01]. This result was in line with several recently published studies 58–60. This benefit could be attributed to the better visual field and more precise identification of structures with the assistance of a robot system, improving the preservation of the pulmonary parenchyma and nerves, especially the pulmonary branches of the vagus nerve 61.…”

Section: Discussionsupporting

confidence: 89%

“…This result was in line with several recently published studies. [58][59][60] This benefit could be attributed to the better visual field and more precise identification of structures with the assistance of a robot system, improving the preservation of the pulmonary parenchyma and nerves, especially the pulmonary branches of the vagus nerve. 61 The well-reserved structure of the vagus nerve regulates many important pulmonary functions, including cough reflex, mucous production, and bronchus diameter, which restrain the presence of pneumonia and accelerate postoperative recovery.…”

Section: Discussionmentioning

confidence: 99%

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Robotic Versus Conventional Minimally Invasive Esophagectomy for Esophageal Cancer

et al. 2022

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Objectives: To give a comprehensive review of the literature comparing perioperative outcomes and long-term survival with robotic-assisted minimally invasive esophagectomy (RAMIE) versus minimally invasive esophagectomy (MIE) for esophageal cancer. Background: Curative minimally invasive surgical treatment for esophageal cancer includes RAMIE and conventional MIE. It remains controversial whether RAMIE is comparable to MIE. Methods: This review was registered at the International Prospective Register of Systematic Reviews (CRD42021260963). A systematic search of databases was conducted. Perioperative outcomes and long-term survival were analyzed and subgroup analysis was conducted. Cumulative meta-analysis was performed to track therapeutic effectiveness. Results: Eighteen studies were included and a total of 2932 patients (92.88% squamous cell carcinoma, 29.83% neoadjuvant therapy, and 38.93% stage III-IV), 1418 underwent RAMIE and 1514 underwent MIE, were analyzed. The number of total lymph nodes (LNs) [23.35 (95% CI: 21.41–25.29) vs 21.98 (95% CI: 20.31–23.65); mean difference (MD) = 1.18; 95% CI: 0.06–2.30; P=0.04], abdominal LNs [9.05 (95% CI: 8.16–9.94) vs 7.75 (95% CI: 6.62–8.88); MD = 1.04; 95% CI: 0.19–1.89; P=0.02] and LNs along the left recurrent laryngeal nerve [1.74 (95% CI: 1.04–2.43) vs 1.34 (95% CI: 0.32–2.35); MD = 0.22; 95% CI: 0.09–0.35; P <0.001] were significantly higher in the RAMIE group. RAMIE is associated with a lower incidence of pneumonia [9.61% (95% CI: 7.38%–11.84%) vs 14.74% (95% CI: 11.62%–18.15%); odds ratio = 0.73; 95% CI: 0.58-0.93; P=0.01]. Meanwhile, other perioperative outcomes, such as operative time, blood loss, length of hospital stay, 30/90-day mortality, and R0 resection, showed no significant difference between the two groups. Regarding long-term survival, the 3-year overall survival was similar in the two groups, whereas patients undergoing RAMIE had a higher rate of 3-year disease-free survival compared with the MIE group [77.98% (95% CI: 72.77%–82.43%) vs 70.65% (95% CI: 63.87%–77.00%); odds ratio = 1.42; 95% CI: 1.11–1.83; P=0.006]. A cumulative meta-analysis conducted for each outcome demonstrated relatively stable effects in the two groups. Analyses of each subgroup showed similar overall outcomes. Conclusions: RAMIE is a safe and feasible alternative to MIE in the treatment of resectable esophageal cancer with comparable perioperative outcomes and seems to indicate a possible superiority in LNs dissection in the abdominal cavity, and LNs dissected along the left recurrent laryngeal nerve and 3-year disease-free survival in particular in esophageal squamous cell carcinoma. Further randomized studies are needed to better evaluate the long-term benefits of RAMIE compared with MIE.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Robotic Versus Conventional Minimally Invasive Esophagectomy for Esophageal Cancer

et al. 2022

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“…Both abdominal and mediastinal lymph node dissection seem to be superior after RAMIE, being more beneficial in the lymphadenectomy across the right laryngeal nerve [ 44 ]. Overall, what is clear among most of the reviews, including the present study, is that the intraoperative, perioperative, and overall clinical outcomes following MIE and RAMIE in high-volume centers are better compared with the open approach, whereas the long-term postoperative results of both MIE and RAMIE are at least equivalent [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

The Implementation of Minimally Invasive Surgery in the Treatment of Esophageal Cancer: A Step Toward Better Outcomes?

et al. 2022

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Esophagectomy is considered the cornerstone of the radical treatment of esophageal cancer. In the past decades, minimally invasive techniques including robot-assisted approaches have become popular. The aim of minimally invasive surgery is to reduce the surgical trauma, resulting in faster recovery, reduction in complications, and better quality of life after surgery. Secondly, a more precise dissection may lead to better oncological outcomes. As such, minimally invasive esophagectomy is now seen by many as the standard surgical approach. However, evidence supporting this viewpoint is limited. This narrative review summarizes recent prospectively designed studies on minimally invasive esophagectomy.

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“…This systematic review and meta-analysis directly compares relevant short-term outcomes between robot-assisted and conventional minimally invasive esophagectomies in esophageal cancer patients. Previous meta-analysis [ 17 – 24 ] concluded that RAMIE is a superior surgical approach when compared to cMIE regarding blood loss, number of harvested lymph nodes, RLN palsy and pulmonary complications, while operating time is shorter in cMIE. Nonetheless, some of these results are also associated with a high percentage of heterogeneity among the studies, compromising their validity.…”

Section: Discussionmentioning

confidence: 99%

“…RAMIE was associated with a tendency of longer operating time, less estimated blood loss and shorter length of hospital stay. RAMIE also yielded a larger number of lymph nodes and had lower rates of pulmonary complications when compared to cMIE [ 17 – 24 ].…”

Section: Introductionmentioning

confidence: 99%

Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy for esophageal cancer: a systematic review and meta-analysis of 18,187 patients

Perry,

Barbosa,

Perry

et al. 2024

J Robotic Surg

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The role of robotic surgery in the curative-intent treatment of esophageal cancer patients is yet to be defined. To compare short-term outcomes between conventional minimally invasive (cMIE) and robot-assisted minimally invasive esophagectomy (RAMIE) in esophageal cancer patients. PubMed, Web of Science and Cochrane Library were systematically searched. The included studies compared short-term outcomes between cMIE and RAMIE. Individual risk of bias was calculated using the MINORS and RoB2 scales. There were no statistically significant differences between RAMIE and cMIE regarding conversion to open procedure, mean number of harvested lymph nodes in the mediastinum, abdomen and along the right recurrent laryngeal nerve (RLN), 30- and 90-day mortality rates, chyle leakage, RLN palsy as well as cardiac and infectious complication rates. Estimated blood loss (MD − 71.78 mL, p < 0.00001), total number of harvested lymph nodes (MD 2.18 nodes, p < 0.0001) and along the left RLN (MD 0.73 nodes, p = 0.03), pulmonary complications (RR 0.70, p = 0.001) and length of hospital stay (MD − 3.03 days, p < 0.0001) are outcomes that favored RAMIE. A significantly shorter operating time (MD 29.01 min, p = 0.004) and a lower rate of anastomotic leakage (RR 1.23, p = 0.0005) were seen in cMIE. RAMIE has indicated to be a safe and feasible alternative to cMIE, with a tendency towards superiority in blood loss, lymph node yield, pulmonary complications and length of hospital stay. There was significant heterogeneity among studies for some of the outcomes measured. Further studies are necessary to confirm these results and overcome current limitations.

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McKeown esophagectomy: robot-assisted versus conventional minimally invasive technique—systematic review and meta-analysis

Cited by 7 publications

References 47 publications

Robotic Versus Conventional Minimally Invasive Esophagectomy for Esophageal Cancer

Robotic Versus Conventional Minimally Invasive Esophagectomy for Esophageal Cancer

The Implementation of Minimally Invasive Surgery in the Treatment of Esophageal Cancer: A Step Toward Better Outcomes?

Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy for esophageal cancer: a systematic review and meta-analysis of 18,187 patients

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