Meta-analysis of robot-assisted versus video-assisted McKeown esophagectomy for esophageal cancer

Magouliotis, Dimitrios; Zotos, Prokopis-Andreas; Fergadi, M.; Koukousaki, Despoina; Zacharoulis, Dimitris; Spiliopoulos, Kyriakos; Athanasiou, Thanos

doi:10.1007/s13304-022-01343-0

Cited by 3 publications

(8 citation statements)

References 27 publications

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“…Early mortality rates had no statistically significant differences between the two surgical approaches. The same conclusion was attained by previous meta-analyses [ 17 , 18 , 20 – 24 ]. 30-day mortality rates are below 2% and 90-day rates are below 5% in both groups.…”

Section: Discussionsupporting

confidence: 89%

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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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Section: Discussionsupporting

confidence: 89%

“…Cardiac and infectious complications had similar rates of occurrence in the two surgical techniques. Recent meta-analyses present similar results [ 17 , 18 , 20 , 22 – 24 ].…”

Section: Discussionsupporting

confidence: 59%

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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“…Further minimally invasive surgical procedures may help reduce post‐esophagectomy morbidities in patients with high LAVRs. A randomized controlled trial suggested that robot‐assisted esophagectomy may reduce the incidence of postoperative pneumonia compared with MIE 34 . One retrospective study in 200 patients with esophageal squamous cell carcinoma reported that mediastinoscopic esophagectomy significantly reduces the incidence of respiratory morbidity compared with MIE 35 .…”

Section: Discussionmentioning

confidence: 99%

“…A randomized controlled trial suggested that robot‐assisted esophagectomy may reduce the incidence of postoperative pneumonia compared with MIE. 34 One retrospective study in 200 patients with esophageal squamous cell carcinoma reported that mediastinoscopic esophagectomy significantly reduces the incidence of respiratory morbidity compared with MIE. 35 Post‐esophagectomy morbidity can reduce patient prognosis.…”

Section: Discussionmentioning

confidence: 99%

Relationship between the severity of emphysematous change in the lung and morbidity after esophagectomy for esophageal cancer: A retrospective study on a novel strategy for risk prediction

Horinouchi,

Yoshida,

Shiraishi

et al. 2023

Thoracic Cancer

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BackgroundChronic obstructive pulmonary disease (COPD) prevalence increases post‐esophagectomy morbidity. However, the association between COPD severity and post‐esophagectomy morbidity remains unclear because of the lack of an objective method to classify COPD severity. Low attenuation volume ratio (LAVR) estimated using Ziostation2 may reflect the extent of emphysematous changes in the lungs and COPD severity, thereby predicting post‐esophagectomy morbidity.MethodsA total of 776 patients who underwent curative McKeown esophagectomy for esophageal cancer between April 2005 and June 2021 were included. The patients were divided into high and low preoperative LAVR groups. Short‐term outcomes between the groups were compared for patients who underwent open esophagectomy (OE) and minimally invasive esophagectomy (MIE).ResultsA total of 219 (28%) patients were classified into the high LAVR group. High LAVR was significantly associated with disadvantageous patient characteristics such as advanced age, heavy smoking, and impaired respiratory function. Patients with high LAVR had a significantly higher incidence of severe morbidity and pneumonia after OE. High LAVR was an independent risk factor for severe morbidity (odds ratio [OR], 2.52; 95% confidence interval [CI]: 1.237–5.143; p = 0.011) and pneumonia (OR, 2.12; 95% CI: 1.003–4.493; p = 0.049) after OE. Meanwhile, LAVR was not correlated with the incidence of post‐MIE morbidity.ConclusionsLAVR may reflect COPD severity and predict severe morbidity and pneumonia after OE, but not after MIE. Less invasiveness of MIE may alleviate the effects of various disadvantageous backgrounds associated with high LAVR on worse short‐term outcomes.

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“…We summarized differences in the operative and postoperative outcomes between RAMIE and MIE or OE in Tables 2 and 3. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] Concerning this issue, we found 12 meta-analyses and 2 RCTs. In many studies, operation time was longer in RAMIE than in OE or MIE.…”

Section: Operative and Postoperative Outcomesmentioning

confidence: 99%

Robotic-Assisted Esophagectomy: Current Situation and Future Perspectives

Watanabe

Kuriyama

Terayama

et al. 2023

ATCS

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Robotic-assisted minimally invasive esophagectomy (RAMIE) has been rapidly spreading worldwide as a novel minimally invasive approach for esophageal cancer. This narrative review aimed to elucidate the current situation and future perspectives of RAMIE for esophageal cancer. References were searched using PubMed and Embase for studies published up to 8 April 2023. Search terms included “esophagectomy” or “esophageal cancer” and “robot” or “robotic” or “robotic-assisted.” There are several different uses for the robot in esophagectomy. Overall complications are equivalent or may be less in RAMIE than in open esophagectomy and conventional (thoracoscopic) minimally invasive esophagectomy. Several meta-analyses demonstrated the possibility of RAMIE in reducing pulmonary complications, although the equivalent incidence was observed in two randomized controlled trials. RAMIE may increase the number of dissected lymph nodes, especially in the left recurrent laryngeal nerve area. Long-term outcomes are comparable between the procedures, although further research is required. Further progress in robotic technology combined with artificial intelligence is expected.

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Meta-analysis of robot-assisted versus video-assisted McKeown esophagectomy for esophageal cancer

Cited by 3 publications

References 27 publications

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

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

Relationship between the severity of emphysematous change in the lung and morbidity after esophagectomy for esophageal cancer: A retrospective study on a novel strategy for risk prediction

Robotic-Assisted Esophagectomy: Current Situation and Future Perspectives

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