Oncologic Resection in Laparoscopic Versus Robotic Transhiatal Esophagectomy

Abstract

Background and Objectives: As the use of robotic surgery continues to increase, little is known about robotic oncologic outcomes compared with traditional methods in esophagectomy. The aim of this study was to examine the perioperative oncologic outcomes of patients undergoing laparoscopic versus robot-assisted transhiatal esophagectomy (THE). Methods: Thirty-six consecutive patients who underwent laparoscopic and robot-assisted THE for malignant disease over a 3-year period were identified in a retrospective database. Eighteen patients underwent robotic-assisted THE with cervical anastomosis, and 18 patients underwent laparoscopic THE. All procedures were performed by a single foregut and thoracic surgeon. Results: Patient demographics were similar between the 2 groups with no significant differences. Lymph node yields for both laparoscopic and robot-assisted THE were similar at 13.9 and 14.3, respectively ( P = .90). Ninety-four percent of each group underwent R0 margins, but only 1 patient from each modality had microscopic positive margins. All of the robot-assisted patients underwent neoadjuvant chemoradiation, whereas 83.3% underwent neoadjuvant therapy in the laparoscopy group ( P = .23). Clinical and pathologic stagings were similar in each group. There was 1 death after laparoscopic surgery in a cirrhotic patient and no mortalities among the robot-assisted THE patients ( P = .99). One patient from each group experienced an anastomotic leak, but neither patient required further intervention. Conclusions: Laparoscopic and robot-assisted THEs yield similar perioperative oncologic results including lymph node yield and margin status. In the transition from laparoscopic surgery, robotic surgery should be considered oncologically noninferior compared with laparoscopy.

Comparison of Clinical Outcomes of Robot-Assisted, Video-Assisted, and Open Esophagectomy for Esophageal Cancer

“…The pooled random effects result was an adjusted RD of 0.0 (95% CI, −0.03 to 0.03; I 2 = 5.4%) (Figure 3A). The RCT 24 and 5 unmatched observational studies 43,47,48,51,55 similarly showed no difference between approaches. Of the additional studies, a cervical anastomosis was used in 4 studies ( 3McKeown 24,43,51 ; 1 transhiatal 55 ).…”

“…The RCT 24 and 5 unmatched observational studies 43,47,48,51,55 similarly showed no difference between approaches. Of the additional studies, a cervical anastomosis was used in 4 studies ( 3McKeown 24,43,51 ; 1 transhiatal 55 ). One study 47 was from a large database and compared robotassisted Ivor-Lewis with an unspecified transthoracic VAMIE, suggesting at least 1 study group had an intrathoracic anastomosis.…”

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

“…Interestingly, the authors reported using biologic mesh to reinforce the hiatus to address the issue of postoperative diaphragmatic hernias, a step rarely performed today [27,41] . Others have also reported similar outcomes [84][85][86][87] . More recently, Wecowski et al [88] prospectively reported their experience in incorporating a robotic platform for transhiatal esophagectomy.…”

Patient reported outcomes (PROs) after minimally invasive and open esophagectomy

“…There are currently a limited number of studies evaluating robotic transhiatal esophagectomies, none of which are randomized. Although some authors have reported similar oncologic results in robotic transhiatal resections compared to open (21,22), no study has reported PROs. Overall, further randomized perspective studies need to be performed to provide any definitive conclusions.…”